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CNM vs. CPM

1K views 20 replies 14 participants last post by  pinksprklybarefoot 
#1 ·
Has anyone used a CNM? I'm looking to use one but in a birth center. The only reason i'm looking at a CNM vs. CPM is because medicaid pays for a CNM, and DH is in school, and we're pretty broke after the first 2 hospital births, etc!! I'm just wondering what a CNM does exactly.....based on other mama's experiences. i have read so much online...i want real stories if anyone has any. i do NOT want another hospital birth if i can avoid it, but DH really doesn't think we can pay out of pocket for a birth center (and isn't comfortable with a HB) so basically, i just want to know how everything went as far as how holistic she was, if you ever had to see an OB, if you got an ultrasound, if your birth was uninhibited by any medical mindedness (or whatever you want to call it), and anything else you can think of. i'm hoping to get positive and negative answers here, so please be honest
TIA!!!!!
 
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#2 ·
I saw CNMs with my first pregnancy. They operated out of the same health center with some OBs. I didn't have to have anyone else do any prenatal stuff for me. (but I did have to have an actual doctor slice me up for my C-section) I certainly can't speak for CNMs everywhere, but IME, they are more "medical-minded" as you put it than a CPM or LM. I was on Medicaid too at the time, so that was why I chose them - although I knew nothing about the differences between midwives at the time. I just thought "a midwife's a midwife."

And since you asked for both positive and negative answers, I did not have a very good experience with the CNM that was on call for my birth. I went in with a natural birth plan and wound up with every intervention in the book including the mother of them all. I didn't really gel well with most of the MWs at that practice anyway, at least not the older ones. There were two younger ones that I liked a lot, but neither of them were on call that night. And I'm not saying that older CNMs are worse than younger ones, but that's just my experience and age happened to be a factor that discerned between them.
 
#3 ·
I used a homebirth CNM for DD2's birth, she used be a MW in TX for a birthing center for years before "retiring" to CO
She was very laidback, I don't do ultrasounds nor any prenatal testing and she didn't bat an eye. I never stepped on a scale, checked my urine, nothing, she didn't care. She would ask me when I wanted to come in for a prenatal, we only did a handful, and they only consisted of checking my BP, listening to baby, and feeling where baby was at. She was much more low key then the RM I had originally planned on using (my state has RM instead of CPM) I never had to see anyone besides her, oh I met her backup MW once but that was it.
 
#4 ·
I am using a CNM now and have seen her twice so far (11wks along). I really like her, she is in the office with 1 OB and 1 nurse practicioner. She delivers at hospitals and she is very encouraging of natural birth. On my first visit with her she said her goal is to give me the low key hands off approach of a homebirth with the safety of a hospital birth just in case. I actually picked her because she is the only provider I found in the Phx area that does waterbirth in hospitals. I have had the standard blood tests and ultrasounds that a regular OB offers, but she didn't offer any extra tests (amnio, NT, CVS etc) unless I asked for it.
 
#5 ·
It depends on the midwife. I've known some CNMs who are as medically-minded as a typical OB. I've known others who are more naturally-minded.

Personally, I choose a CPM because I prefer a midwife who specializes in out-of-hospital birth. My midwife did 4-5 years of out-of-hospital midwifery training instead of 4 years of nursing (a lot of which has nothing to do with birth) and 2 years in hospital-based midwifery. In my area, CNMs do not attend home births. There are a small number of CNMs at a free standing birth center, but they have many more restrictions on how they practice because of the relationship they have to maintain with a back-up OB. I like that my CPM has more freedom because that lets ME make more of my own choices regarding my health care.
 
#7 ·
My mom is a CNM and I've used CNMs for both of my children (well, expecting #2 in June this year). I think Ina May Gaskin sums it up best.... there are some OBs who practice with a midwifery model of care, and there are some midwives who practice with a medical model of care. It's a quesiton of finding someone whose philosophy you agree with.

I like the extra medical training that CNMs have - they're all RNs and if things go south I feel very confident that they will (a) know what to do and (b) know their own limitations and when to ask for help. This is probably true of most CPMs too. My current group of CNMs are very hands-off, and I like this. The CNMs that I saw when I had my son were a bit more medical as a group (with one notable exception) and honestly, this was somewhat of a shock to me. I had always assumed, growing up with my mom, that any woman who went to a midwife was someone who assumed and expected an intervention-free birth experience. While the CNMs that I saw the first time around were certainly willing to support that desire, I got the impression that for their clientelle, this was not necessarily the assumption or the norm. It's one reason (among many) that I switched when I got pregnant with #2.

So.... my advice would be to interview a few people, ask them about their general philosophy, and decide based on the individual. If your insurance will only cover a CNM, you shouldn't have any trouble finding one who will be great.
 
#9 ·
I think you need to speak with the CNMs you are looking at.

I interviewed a 2 CNMs, a CPM, and a LM. I actually ended up choosing a CNM because I found her the most hands off and able to listen to and accept what i wanted. The CPM I interviewed wanted to run things her way.

Now I also interviewed another CNM nearby and she definately seemed medically minded and had a list of tests and ultrasounds we wanted.

I don't know if this makes a difference in your case but all of these mws were HB mws.
 
#10 ·
Okay, all such great info. Thank you all so much for your honesty. Now, how do I go about finding a CNM in my area who delivers at a Birth center?
 
#12 ·
Yes, I have actually PM'd all/most of the mamas in my tribe. I am in Hurst, TX. I have searched online, etc. and it just seems that I can find plenty of CPMs, but no CNMs!!! (The closest CNM and birth center is about an hour away.)
 
#14 ·
Quote:

Originally Posted by alegna View Post

There is nothing safer about a birth center than a homebirth.

-Angela
Hmm, that's an interesting comment. Can you expound on that? I'd also love to hear other mama's views here. I haven't experienced either, so I'm really interested in this
(my first 2 were hospital births)
 
#15 ·
Well, typically the only safety reason to choose a birth center over a homebirth would be if you lived in the boonies, and felt that you were too far from a hospital for quick transport should an emergency arise.

Other than that, the midwife will typically have the exact same supplies and whatnot at a birth center that she would bring to a homebirth. It's just a mental perception for some people that home isn't safe...

I agree with the earlier posters-- just interview around and see whose birth philosophy meshes well with yours.
 
#16 ·
Quote:

Originally Posted by Chiroalltheway View Post
Hmm, that's an interesting comment. Can you expound on that? I'd also love to hear other mama's views here. I haven't experienced either, so I'm really interested in this
(my first 2 were hospital births)
The only reason to choose a birth center is if your home is an unsafe place to birth for some reason (exceedingly far from a hospital, in the middle of dangerous construction, filled with hostile people
etc)

A homebirth midwife brings with them all equipment that would be at a birth center.

A birth center has nothing a homebirth midwife doesn't.

Make sense?

-Angela
 
#17 ·
For my second child I went to a group of CNM's. I thought they were great. They weren't pushy and I had a natural hospital birth. I would have had a water birth but I showed up too late. I never saw the OB they worked under. You only saw him if you/baby have more than minor medical issues. I liked that the midwives were RN's, it made me feel confident that they would recognize a problem that may not necessarily be only related to pregnancy, labor, and delivery. I think a wide range of medical knowledge with a specific area of expertise is important. But everyone has different things that are important to them. For my first birth I had an OB and I was not happy with my care. Good luck in your decision!
 
#18 ·
I used CNMs in a hospital with my first birth and CPMs for my second birth (homebirth) and am using CPMs again in this pregnancy.

I had a very good experience with both types of mws. Both had a lot of expertise and were good at coaching me through labor in a helpful but low-intervention and respectful way. Here are what I've found to be the advantages of each type:

Pro - CNM: 1) they have hospital privileges and can interface with hospital staff to make sure everyone respects our birth plan as much as possible. This wouldn't necessarily be true if a homebirth/birth center birth turned into a hospital transfer. 2) They have a close working relationship with a backup OB. Our CPMs also use a backup OB, but he is further away. 3) Their office is more of an office - it can be easier to get in touch with them, schedule appts, etc.

Pro - CPM: 1) CNMs are (at least ours were) a bit more medical and less flexible than CPMs. They are more likely to insist on the typical routine tests. One issue we had was that I tested as having a mild UTI. I wanted to try treating with cranberry extract first, they wanted to do abx right away. They "let" me decline the abx but did give me some flack over it. 2) There are (at least IMO) a number of disadvantages to delivering in a hospital - paperwork, hoops to jump through, staff which may not be as respectful/helpful as desired, and of course the stress over exactly when to leave for the hospital. And the stress of getting to the hospital and being admitted (transition in hopsital parking lot - not fun). Not all of these apply to a birth center but the last one definitely does. 3) We had an easier time developing a personal relationship with our CPMs - they were just more personable and the whole atmosphere more casual, so our appointments were almost more like visiting a friend than a medical visit.

I had the exact same amount of contact with OBs with each birth - I saw one once, for an ultrasound mid-pregnancy. Neither ever saw the baby or was present at the birth.

I think you can have a great experience either way. I would definitely interview all the mws you can find. Also, if you are using a hospital or birth center it is important to find out their policies, and also what sort of facilities they have - can you shower during labor, labor or birth in a tub, etc. I was able to labor in the water for our CNM birth, but not birth in the water - for our CPM birth I delivered in the birth tub and found it a tremendous help in maintaining my comfort and a feeling of control in the pushing stage.

Are you sure medicaid won't cover a CPM/homebirth? It does in Vermont. There is some good research out there showing that homebirth is just as safe as hospital birth, maybe that would convince your dh.

Hope this post wasn't too long...
 
#19 ·
Quote:

Originally Posted by Catherine12 View Post
Pro - CNM: 1) they have hospital privileges and can interface with hospital staff to make sure everyone respects our birth plan as much as possible. This wouldn't necessarily be true if a homebirth/birth center birth turned into a hospital transfer. 2) They have a close working relationship with a backup OB. Our CPMs also use a backup OB, but he is further away. 3) Their office is more of an office - it can be easier to get in touch with them, schedule appts, etc.
FWIW none of these 3 are true here. None of the birth center or homebirth midwives have hospital privileges. None have a close working relationship with an OB and none have full offices.

-Angela
 
#20 ·
Quote:

Originally Posted by alegna View Post
FWIW none of these 3 are true here. None of the birth center or homebirth midwives have hospital privileges. None have a close working relationship with an OB and none have full offices.

-Angela
Same with where I am at. My CNM would not even allowed into the hospital in case of a transfer, she had no relationship with any OB, and no office. I went to her house for appointments.
 
#21 ·
I planned a CPM homebirth but wound up using the CNM recommended by my CPM for a hospital birth when I developed PIH/pre-e. I planned a homebirth even though I was on medicaid. Medicaid covered a hopsital birth, but not a homebirth. We wound up paying about $2500 out-of-pocket for the homebirth portion (somehow, out CPM's biller was able to squeeze something out of the company contracted to provide my MA benefits).

I had a great experience with my CNM. We really clicked. I did go in (at 37 wks) with a long list of dos and don'ts as a birth plan. She knew I wanted a natural birth and helped me achieve that even though I was forced into a hospital setting (and by the way things went, it was good that I was in a hospital. I would have had to transfer if I had attempted the HB).

I really had a great birth. Even though it was in the hospital.

One caveat, I stayed at home for as long as I could and arrived at the hospital around 8 cm with my CPM in tow as my "doula." I was at the hospital for only about two hours before DS was born. I had the pre-e, so things went very fast and I was definitely in laborland for most of the hospital portion.

I love the CNM that attended DS's birth so much that I still use her as my primary care. Until I met her, I was never greeted at my yearly pap smear appointment with a hug.


If I were to get pg again, I would plan a hospital birth again simply because I click with this CNM so well.

With regard to advice to the OP, I am in MN, which, from what I've heard, is vastly different from TX. From the little I've heard about TX, if I could avoid a hospital birth, I would. Including scraping up the $$$ to pay for a homebirth (which I did anyway, despite the hospital birth).

I did see an OB through most of my pregnancy for the sake of getting an US and other tests that I felt necessary given my family history. MY CPM could have done some of these, but MA paid for them if I went to an OB, so I saw both the CPM and the OB for many months.

The moral of the story for me was to find someone that I really clicked with. Regardless of where she practices. Although, I will never know to what degree the fact that I was a homebirth transfer influenced my treatment from my CPM. I will always wonder if the fact that I was originally planning to do everything at home with no epidural. etc made it more likely that she didn't offer it in the first place (as in she knew I was serious because in my ideal birthing situation, pain meds would not even be available). But, on the other hand, I know that she is pro-natural birth (and was very excited by the way mine turned out), so she probably wouldn't have pushed meds on me anyway.

One last thing: When I went in for my yearly exam, she told me how proud she was of me that I was still nursing. Now I am proud of myself that I am still nursing, have no plans to stop any time soon, and know that it is the best thing that I can do for DS. But it was nice to get the support. It was nice to feel as if someone was on my side. It was nice to have a healthcare provider that understood thje importance of bfing, and had bfed her own children.

Bottom line, it doesn't matter so much the letters after their name as how you feel about them. Regardless of price. If you have to pay out-of-pocket, you'll find a way. Just find the person that you are the most at ease with. If she wasn't my main healthcare provider, I would totally go out for a drink with this woman.
 
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