CNM's vs. Direct Entry Midwives - Mothering Forums
Homebirth > CNM's vs. Direct Entry Midwives
Becky N.'s Avatar Becky N. 04:29 AM 02-05-2002
From everyone's personal experiences, did you find any real difference between CNM's and direct entry midwives?? Did you find one more qualified, or more likely to use medical intervention, or does it just depend on the individual? My good friend is an RN and of course, thinks that a CNM would be much safer and well trained. I tend to disagree, but have no experience thus far in the subject, so please, let me know what YOU think!!!
Thanks a ton! Becky

kerikadi's Avatar kerikadi 12:15 PM 02-05-2002
At first I didn't think I would want a CNM. I worried that she would want more intervention than I am comfortable with. However, talking with 8 midwives over the phone and meeting with 4 in person, I can say I was wrong.
I had a direct entry midwife tell me that because of an incompetent cervix with #2, which was 7 years ago, that I would not be able to carry to term and may not be a HB candidate. All of this over the phone before she even met me or had details.
I met with 1 CNM and 3 direct entry. Ironically I chose the CNM. She was the most respectful of my wishes.
NO Ultrasound
NO Glucose Testing
NO Goop in the eyes
NO Internal exams
NO Vitamin K shot
NO Doppler

I felt that the direct entry midwives were more worried about covering their own a** and less interested in respecting my wishes.

Good Luck!
cottonwood's Avatar cottonwood 05:12 PM 02-05-2002
I had two homebirths with midwives, the first was a CNM and the second LM. The CNM was very earth-birthy during the pregnancy and kind of fooled me with her anti-intervention rhetoric. During the birth, however, she had this very rigid approach, i.e., that it should progress according to a certain standard. She wanted to be very active in her management of the labor, coaching me on positions and how to breathe, etc. Much timing of contractions and dilation checks, and I ended up pushing from the magic "10 cm", on my back. So in my mind, although she didn't do a lot of things typically considered "inteventionist", like doppler, AROM, etc., the way she behaved felt intrusive and controlling to me, and she had some typically obstetrical views on things (like the forced pushing at 10 cm, and believing that a quick delivery of the placenta was important.) My assumption has always been that she picked that up doing her time in nursing school and the maternity ward. But I know also that some of it was simply what she was required to do because of licensing mandates.

Well, my second midwife was a totally different story. Because she is not licensed (by choice) she is not bound to follow a certain protocol and therefore has a lot of freedom in tailoring her care to her individual clients. She understood the natural process of birth much better than the CNM, who was trained in obstetrical theory. I feel that with the lay midwife I had a *truly* non-interventionist birth. And I felt very comfortable with her ability to diagnose and deal with complications -- she was constantly doing research and always had very detailed and well-documented answers to my questions.
indigolilybear's Avatar indigolilybear 03:27 AM 02-06-2002
well, IMO--of course it does depend on the individual but I think that it is difficult if not impossible to go through a traiing like you do to become a RN and NOT be changed about the "dangers" of the human body and birth. Our system of western medicine is SO focused on disease and what can go wrong and how to cover your a** that I really don't think I'd ever be comfortable w/ someone w/ those credentials. and I am sure that there are plenty of women out there w/ great birht stories w/cnm's. however, i also believe that licensing does create a similar environment and thus LM's may risk the same effects. Though at least they don't have as much of the exposure to the traditional training that CNMs have.

for the record, dd's birth was w/LMs at home and we were not impressed though they were our intuitive choice and I don't regret choosing them. It was just a step in our journey. I would even recommend them ironically....they were good, just not what we ended up wanting.

BTW, I think something I would take into consideration is what kind of births and relationships my midwives had. I believe that my midwives had baggage..well one in particular though both were divorced and kind of man-angry (not that all divorcees are obviously). one midwife had a particularly traumatic tear and a lot of anger at her ex- that was obvious when she spoke to us. In hindsight, I would listen to things like taht more too.
anyway, good luck. follow your heart
lilyka's Avatar lilyka 05:39 PM 02-06-2002
I had a CNM in my first birth and CPM for my second. My CPM was a little into tecnology but never just because it was there. She was very mello and believed inletting my body do its thing even when thigs took a turn for the worse (all the intervention in the world wasn't going to stopit but most Dr. wouldn't have been able to sleep at night if they didn't know every detail of my condition). She is great and I plan on using her for my next birth. She is now at a birthing center in MN. My next was good and very non-intervention, used herbs, very knowledgeable and imformative without testing, basic CPM stuff. I think this group is very consistant as far as skill level and basic philosophy go. (at least around here where it is less than legal). CNM's however run from one extreme to the other. Most of the CNM's here are med-wifes. Dr.s in disguise. There are several Dr. I would recomend before them (I guess we have one good one here. Lisa at McKennan is great for anyone in the area. However Mckennan Hospital sucks and a policy of intervention. You win some you lose some.) Anyway you are more likely to find intervention in a midwife who has been trained by the medical machine. Those who have freed themselves from the hospital payroll will most likely be better and may have grown some.
hawleyclan's Avatar hawleyclan 11:36 PM 02-09-2002
Hi! My second birth was with a CNM at her birthcenter. The main thing I noticed was that when I attended prenatals she made me nervous- the way my doctors did- about my weight gain, my test results, and my due date. I remember one month I gained 3 pounds more than was the "norm", and when I told her my weight she made a point to mention the gain- like I was stashing twinkies... I'm vegetarian... you tell me... Then at one point she said the baby was measuring a bit small, and worried me sick for the next two weeks. At the next visit she never mentioned it once, and said the baby measured fine... She would have liked me to take all the standard precautionary tests to rule out defects, but as I had a choice, I chose not to. I believe she was surprised. By two days past my due date, she was really pushing for an ultrasound, and talking about a possible induction... My last gripe was that she was a real "pushing coacher", and when I hit that "ring of fire" spot, boy did it bug her that I slowed down... I still ended up with a stitch, but I hate to think what the result would have been if I hadn't listened to my body while pushing...

Don't get me wrong, she was a sweet lady, and the whole experience was good. Much better than the hospital birth I had before... But the next time around, I was looking for a homebirth midwife... I just want someone who I can be certain isn't transferring her fear of negative outcome onto me in prenatals and into my labor... If the baby were in trouble, I would push if it meant a 4th degree tear (my hospital birth came with the standard episiotomy/4th degree tear combo...) But if all is well, trust me, I'm doing all I can to get that baby out as my body leads...

Just my experience... and I would go back to her if I had to choose between hospital and the birthcenter... But I'd rather a repeat of the last two, safe in my home, birthing in my nest...

The Lord bless you,
Zoie
Natashka's Avatar Natashka 06:38 AM 02-13-2002
I've only interviewed one LM before a homebirth. Seen several CNMs in hospital setting, interviewed CNMs before a homebirth and ended up choosing CNMs for a homebirth, with no regrets.
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