CPM vs. CNM - Mothering Forums

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#1 of 14 Old 02-25-2011, 09:47 AM - Thread Starter
 
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In the past, I have only used CNM's for my births.  One was in the hospital, one was at home, and with both, I was really happy with their experience and everything, and also glad for the back-up medical equipment, like pitocin and oxygen, just in case something went wrong. 

 

I've moved since then, and I'm finding that the only midwives in the area who do homebirths (my preference by far) are CPMs.  Now, I'm not extremely clear on the difference, but I believe that means that they won't have access to things like oxygen and pitocin, and won't be able to prescribe medication if I need it, either.  Is that correct? 

 

I have a consultation with a CPM next Wednesday, and of course I will discuss these sorts of things with her, but in the meantime, I just can't get my mind off of it.  What sort of things can a CPM do in case of emergencies like hemmorage?  Are there other limitations that a CPM has that a CNM doesn't?  Do you personally have experience with homebirth with a CPM, and what were your general feelings about it?

 

I'm not extremely worried, because I don't have a history of complications, and I'm within 15 minutes of 3 different hospitals, but it's still in the back of my mind. 


SAHM to Melinda (Oct '03), Jacob (Aug '05),  Alex (Apr '08), and baby.gif Malcolm (Sept 29, '11)

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#2 of 14 Old 02-25-2011, 10:07 AM
 
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seems to be very different depending on the state. see if you can find a midwife in co who explains it on her site (I noticed in cali many did). In San Diego, where I was for my HB (for #2) CNMs did not attend HBs. They worked in hospitals and birth centers (like where I had #1). There we had "licensed midwives" (LM) and they absolutely could carry pitocin, could test for Rh factor, carried oxygen, etc. They were licensed for the medical devices relevant for birth. They were covered by insurance. They could not order tests (well, they could do blood tests but not ultrasounds) or prescriptions, so you had to see a dr if you wanted any of that.

 

Going to start interviewing here next week- noticing many of the HB MWs are CNMs. So I'll be asking some things in reverse here...

 

I am sure others here can give you a lot more info, but yes, get this on your list of questions for the initial meetings!


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#3 of 14 Old 02-25-2011, 12:15 PM
 
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I would never work with anyone who was not a CNM.

 

I say this as a mom who attempted a HB last time with a CPM.  She was wildly unprofessional.  She was not licensed in our state as she had recently moved here.  She ended up not attending my birth and leaving me in the care of two people who were even less qualified than she was.  She had no backups.  It was just bad all around.  

 

A CNM has to go to actual medical school.  My "midwife" did her classes online and then shadowed births with local midwives in the area.  I was always astounded by how few births she had to attend before she got her CPM.

 

I just wouldn't risk it, but I'm gunshy.  I know several moms who used this midwife and loved her.  Of course, she actually showed up for their births...


Loving wife to a wonderful and Godly man, hug.gif  and SAHM to two beautiful boys, DS1, natural hospital birth (2/2010) and DS2, beautiful homebirth (10/2011) cd.gifnursex2.gif

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#4 of 14 Old 02-25-2011, 01:49 PM
 
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I had a CNM with my son and she was really just an OB in disguise.  I feel like they sometimes plant those CNMs in OB offices to draw the women who are looking for more natural options but then turn around and practice within the Obstetrical Method of Maternity Care.  Thankfully I have a CPM who I know very well and who also attended a very good school and training program.  She has all the medical training any other CNM would have.  She also brings oxygen and such.  I'm sure there are good and bad of both types but my past experience steers me to the CPM and I will have a MD (midwife in disguise) as my back up doctor.  


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#5 of 14 Old 02-25-2011, 01:51 PM
 
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As other people mentioned, it does vary by state whether CNMs can attend homebirths or not.  In my state (MA), they cannot, so homebirths are attended by CPMs or direct-entry lay-midwives. 

 

A CNM has a nursing degree in addition to midwifery training, and they usually work in hospitals.  Generally, they are less interventionist than doctors, but sometimes they can find their hands tied by policies (risking out certain woman, postdates etc).  They may also have a more "medical" model.  A CNM does not go to medical school, however.

 

A CPM is also a certified midwife who is licensed and certified by NARM.  In CO, I believe HB midwives cannot suture, but a CPM is trained and qualified for most birth emergencies.  A CPM attending a homebirth would (should) come with emergency supplies, and usually a backup midwife. These include oxygen, neonatal resuscitation (deLee suction), as well as drugs.  They would not induce labor with pitocin, but if you were hemorrhaging after birth, they would give you pitocin or methergyn to stop the hemorrhage.  The reason you'd likely have 2 is that one can focus on the mother and one can focus on the baby.  A CPM is a good option for a healthy low-risk woman who choses to have a homebirth.  A good CPM will pre-screen her clients, and over the course of the pregnancy develop a relationship with you.  You should ask about transfer rates, experience, philosophies (i.e. cutting cord immediately vs. waiting until Placenta is out).  NDFanatik had a great post on questions to ask a midwife.  While the majority of transfers to a hospital are non-emergency, in most states a CPM might not have backup doctors (this is due to political reasons, because in many states midwifery is a-legal, meaning it is licensed, but unregulated), so you would have to just show up at the hospital in the even to transfer. 

 

I would definitely meet with different kinds of midwives.  It all depends on what YOU are comfortable with too.  Depending on whether you would prefer having a hospital next door vs giving birth in your own home, both a CPM or a CNM could be an excellent fit for you.  I think the most important thing is having a care provider that YOU are comfortable with.  If you have a bad vibe, trust it, and if you really click with someone, that is important too. 

 

Just so my biases are upfront, I'm training to be a homebirth CPM, so obviously I fully support what CPMs do!  I'm also planning on having a homebirth CPM attend our birth.  In the event we need to transfer, I will have to likely just go to the hospital with whatever doctor is on-call.  I don't think that a homebirth is for everyone, and it is not my place to judge what is right for anyone else.  However, I encourage you to learn more and ask the midwife all of these questions- she will be able to provide you peace of mind more than anyone else here can!  No matter what you decide, I hope you feel inspired and empowered, and find someone you totally connect with to attend your birth!

 

P.S.  Pseudo-diva- I'm sorry you had such a negative experience at your HB- that sounds totally unprofessional. :(


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#6 of 14 Old 02-25-2011, 02:09 PM
 
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Thanks, Amy. It sounds like you're getting excellent training. I'm sure you will be a fantastic CPM!

Loving wife to a wonderful and Godly man, hug.gif  and SAHM to two beautiful boys, DS1, natural hospital birth (2/2010) and DS2, beautiful homebirth (10/2011) cd.gifnursex2.gif

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#7 of 14 Old 02-25-2011, 05:44 PM
 
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I've had an OB, a hospital-based CNM, a homebirth CNM and a homebirth CPM. 

 

My favorite was the CPM, hands down. I know part of it was due to her as a person but I adored her. I am very hands-off. I don't like invasive medical procedures or medical mindsets, overall. I prefer the model of a CPM (or a more natural-mided CNM, of course, there are many), personally. I like the wait and see approach as a rule and I don't like rushing in for tests, medication or procedures. My CPM was fabulous, just wonderful! She embraced the spiritual side of pregnancy and was incredibly supportive as well as very well-trained and experienced. She was more than capable of handling emergencies and she had a sound mind and good judgement. Her calm and confidence in my birthing room was so wonderful. 

 

What a CPM can carry does vary by state but I found her to be quite prepared for any situation that might have arisen, and she carried almost all the same things that my CNM did.

 

Don't get me wrong, there are some benefits to having a CNM (like prescription privileges) and I really loved my homebirth CNM! I just prefer the CPM approach (which, of course, varies with the individual), overall.


Beth )O( Homeschooling Mama to blahblah.gif DS (7) luxlove.gif DD (5) and sleepytime.gif DS (1) & #4 on the way in October!!! love.gif
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#8 of 14 Old 02-25-2011, 05:56 PM - Thread Starter
 
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Wow, I really appreciate all the replies! 

 

I've been fortunate that my CNM experiences have been very natural-minded.  The CNM who attended my homebirth was heaven-sent, I'm sure.  She mostly just sat quietly in the corner and watched me do my thing, only jumping in when my son was born and she needed me to adjust my position in order to make sure he didn't get stuck.  He was a large baby, at 10lb 10oz!  She didn't cut the cord until after the placenta delivered, was able to evaluate my small tear and advise me not to worry about stitches (perfect advice!), and she took care of my rhogam shot (I'm O- and all my babies have been O+).  Her presence was so calm and perfect.

 

Anyway, I'm sure that most likely, I'll find that same attitude in most CPM's.  But having no experience with them, it's wonderful to hear the different input here!  It will really help when it comes time for our consultation appointment.  Amy May, thank you especially for your advice on what sorts of things to look for, and talking about different privileges in different states.  I'm sure that makes a big difference!


SAHM to Melinda (Oct '03), Jacob (Aug '05),  Alex (Apr '08), and baby.gif Malcolm (Sept 29, '11)

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#9 of 14 Old 02-28-2011, 08:54 AM
 
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My pleasure!  I wish I were in CO right now too!  I have no idea what the birth climate is like there, but I know that some of the hospitals in the Boulder/Denver area are "Baby Friendly Hospitals," including Exempla Good Samaritan and Poudre Valley in Ft. Collins.  I don't think Boulder Community Hospital is officially certified, but a close family friend is a childbirth educator there, and their policies are very "baby friendly."  I know this isn't directly related to CNM's or CPMs, personally, it makes me feel good to know that lots of mommas can have a hospital birth with lower interventions, won't be sent home with formula samples, and will be aloud to room-in after birth! 

 

I'm also A neg, and my husband is B+, so most likely baby will be Rh positive.  Did you get rhogam at 28 weeks and after delivery?  More often than that?  Did you do 28 week shot for your first?  I should probably open a new thread for Rh negative mommas...


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#10 of 14 Old 02-28-2011, 09:23 AM - Thread Starter
 
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Well, CO is certainly more friendly than Maryland!  There was only one legal HB midwife in the entire Baltimore region, and even with my lousy midwife research skills, I'm finding at least 10 different HB midwives within a 20 minute drive of me.  It was so hard to go with alternative options in MD.

 

I've thought about giving the friendlier hospitals a chance, but in the end I'd rather be home and guarantee that nobody is going to harass me about Heb B shots or Vit K injections and all the junk I plan on skipping.  Plus I loved the feeling of my homebirth with #3, with our new baby seamlessly integrating into our family, and my kids getting to know him right away.  I hate to think of being away from them for a day or two before I'm "allowed" to go home.  Those are my biggest issues with hospital environments.  I could handle a birth in them, it's the stay afterward that nearly kills my spirit.

 

With my first two pregnancies, I did get the rhogam around 28 weeks and again after birth, but with my last, I opted to only do rhogam after the birth.  I was comfortable with that option based on the reading I did at that time.


SAHM to Melinda (Oct '03), Jacob (Aug '05),  Alex (Apr '08), and baby.gif Malcolm (Sept 29, '11)

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#11 of 14 Old 02-28-2011, 09:41 AM
 
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I am Rh neg and DH is Rh positive. Both my kids so far have been Rh positive.

 

With the hospital birth center CNMs for #1 I had rhogam shot at 28 weeks and again immediately after birth. When she was cleaning and stitching and whatnot, she also just gave me the shot in my butt- barely mentioned it.

 

With the HB MW for #2 (who was a licensed midwife, but not a CNM) I had a rhogam shot while pregnant, and then my midwives had rhogam ready for me, but they tested baby's blood type before administering it. Since DD was positive, they gave me the shot. Their take was that it was unnecessary otherwise, so they wouldn't have recommended it. 

 

With both I was checked for antibodies (blood test)

 

If DH was Rh neg I would have had the option of refusing the rhogam with the HB MW, I suppose I could have with the birth center practice, but they never even discussed the possibility with me. (They didn't even ask. I know why they have that policy- I mean, they don't want to get involved in making medical decisions based on my assertion of who is the father, in case I am wrong or hiding the truth, BUT, it was interesting to see the difference).


My HB midwives told me that I could also just show up at a hospital or clinic w/in 3 days of the birth of baby and request a Rhogam shot and they'd give it (that would have been a cheaper option for me with how my health insurance worked). I decided to pay upfront for my midwives to order it and have it ready because that sounded like a horrid way to spend one of my first 3 PP days.

 

Quote:
Originally Posted by Amy May View Post

My pleasure!  I wish I were in CO right now too!  I have no idea what the birth climate is like there, but I know that some of the hospitals in the Boulder/Denver area are "Baby Friendly Hospitals," including Exempla Good Samaritan and Poudre Valley in Ft. Collins.  I don't think Boulder Community Hospital is officially certified, but a close family friend is a childbirth educator there, and their policies are very "baby friendly."  I know this isn't directly related to CNM's or CPMs, personally, it makes me feel good to know that lots of mommas can have a hospital birth with lower interventions, won't be sent home with formula samples, and will be aloud to room-in after birth! 

 

I'm also A neg, and my husband is B+, so most likely baby will be Rh positive.  Did you get rhogam at 28 weeks and after delivery?  More often than that?  Did you do 28 week shot for your first?  I should probably open a new thread for Rh negative mommas...




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#12 of 14 Old 02-28-2011, 10:38 AM
 
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Hello! I am CO too and I will be using a CPM for a homebirth for this little one. I had DS in the hospital with an OB (the hospital was Baby-Friendly) and decided a different route was better for our family this time. The law surronding CPM is going to "Sunset" this year, which means it will end if it is not renewed. It currently looks like it will be renewed with a few changes. Some of the things they are working on are allowing CPM to carry and give pitocin, the vitiamin K shot, and rhogam and possibly stich first and second degree tears. I would talk with the CPM you are considering because I believe some of them already carry pitocin for example. You can follow more about the law here http://www.coloradomidwives.org/news/legislation-updates .


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#13 of 14 Old 02-28-2011, 01:05 PM - Thread Starter
 
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Quote:
Originally Posted by Poodge View Post

Hello! I am CO too and I will be using a CPM for a homebirth for this little one. I had DS in the hospital with an OB (the hospital was Baby-Friendly) and decided a different route was better for our family this time. The law surronding CPM is going to "Sunset" this year, which means it will end if it is not renewed. It currently looks like it will be renewed with a few changes. Some of the things they are working on are allowing CPM to carry and give pitocin, the vitiamin K shot, and rhogam and possibly stich first and second degree tears. I would talk with the CPM you are considering because I believe some of them already carry pitocin for example. You can follow more about the law here http://www.coloradomidwives.org/news/legislation-updates .


Thanks for that!  :D  All sort of new information for me.


SAHM to Melinda (Oct '03), Jacob (Aug '05),  Alex (Apr '08), and baby.gif Malcolm (Sept 29, '11)

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#14 of 14 Old 02-28-2011, 01:33 PM
 
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http://www.thebirthsurvey.com/

 

That website has good info about different hospitals and how they rank in terms of natural birth.  Good luck!


Loving wife to a wonderful and Godly man, hug.gif  and SAHM to two beautiful boys, DS1, natural hospital birth (2/2010) and DS2, beautiful homebirth (10/2011) cd.gifnursex2.gif

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