How To Choose A Midwife
You’ve been feeling that tug – the one telling you that you should seek out a midwife for this new baby. You may not even be pregnant yet or you may be in your third trimester, but you just know. It’s right for you and you want to make the switch. But where to begin?
In the U.S. there are two types of midwives – CNM and CPM. Certified Nurse Midwives have the extra degree, Certified Professional Midwives are licensed as well, but do not practice in hospitals. Those are the technical aspects, but I want to talk about the other facets of choosing a midwife. Things like birth philosophy, intervention model, how they practice and their personality types. All these things must come into consideration when choosing a midwife because she will be a hugely important person in your life.
I’ve personally had all different types of midwives. I had a midwife hospital birth, I had a CNM home birth, and I’ve had two other CPM midwives who are wildly different in how they practice.
Be sure to think about your own philosophies – are you seeking out a midwife because you want a more gentle spirit but still all the medical model-ish things that your OB would’ve provided? If so then you’ll be wise to stick with CNM’s. Are you wanting a really natural minded midwife who doesn’t intervene unless absolutely necessary, but you aren’t ready for or aren’t interested in a home birth? Then look for CPM’s who practice at a birthing center.
I realize there are exceptions to this rule, but generally CNM is going to be just that…a nurse. A CPM is somewhat free from that type of learning/teaching, so she will be more into the older practices, the tricks like a turkey sandwich during labor to help make you sleepy, ways to help a mal-positioned baby while in labor, things of that category. It all just depends on what you the mama prefer in your care.
Either category of midwives will be much more attentive than an OB would, simply because of the nature of their practice. They typically take on less patients and their procedures are more about you then their protocol. There are still yet exceptions to this however, with midwives who are barely any different from an OB in their philosophy and patient load.
You will want to also consider temperament and personality, and make sure the energy of the midwife you choose is the type of energy you’ll want around you when you’re working the hardest you ever will in your life.
Any other tips for those choosing a new midwife? Please share in the comments!
I had both my babies at home, and switched midwives mid-pregnancy with my first. I needed a midwife who would engage with me as a person, not just medically, especially with all the health junk I’ve had over the years. I needed someone who wouldn’t detach from me or cause me to detach from myself and my baby.
The first CNM I went to was pretty cold – and I had to switch out. I was thinking a hospital/birth center birth, so I found a midwife practice with several CNMs who had a birth center. It was a bit of a drive, but completely worth it to me for the more gentle approach they took, and by the time my pregnancy ended, we had decided completely on a home birth.
It was the best decision we ever made. My baby wasn’t just a health condition, she was a baby. The birth was so gentle, and I felt really confident that the midwife who attended me knew what she was doing and how I was doing.
My second birth was a home birth with a CPM. Since my second pregnancy was a total surprise, she was prefect for me, willing to suggest things like homeopathy and chiropractic help, which were really necessary for me, especially after the long period of PPD I went through after my first.
My advice – trust your heart. If you feel at all uncomfortable with your current care provider, switch. There is more than one midwife out there, more than one who will support you and what you believe about birth. Choose what will make YOU feel safest, because feeling safe is the best way to have a good birth. Both my labors were 5 hours, and the babies came easy. I know a lot of it was because I made the right choice for the care provider I would have with me.
This blog is not very as helpful. Does nothing to shed light on the training differences between a CPM and CNM and basically tells you not to worry about that and go with whoever gives you a warm, fuzzy feeling instead. Not one word about the wildly varying requirements of CPMs per state and doesn’t address the life saving medical supplies a CNM can bring that most CPMs can’t i.e. IV antibiotics if you are GBS+, oxygen and resuscitation equipment, pitocin in case of a post partum hemorrhage. No one expects anything to go wrong during their low risk, normal birth, but it’s a good idea to be prepared just in case. In some states, CPMs don’t have to have a high school diploma and can do all of their training via distance learning programs. NARM only requires a midwife to have three years experience and 50 births under belt before she can become a teacher and apprentice other midwives. There’s a lot more to picking a midwife then a feeling you get from them. You must research your midwives credentials and find out what the laws regarding CPMs and DEMs are in your state to make sure you’re making a safe choice. You shouldn’t have to do that but since there’s no set national standard of care for CPMs like there is for CNMs you do.
A CNM having a degree isn’t a “technical difference” between her and an CPM. It is a world of difference. A CNM is a nurse with a masters in midwifery. A CNM is a nurse who knows how to care for you whatever happens. A CPM has no degree and a much lower standard of education, and is unlikely to have insurance if things do go wrong.
If things go wrong (we hope they don’t) do you really want an uneducated person who has time to chat over cups of tea? Or do you want someone who knows what they’re talking about? Someone who has done the hard yards.
My advice is to make sure your midwife actually has training, knows infant CPR, knows what to do in case of emergency, can administer medicines in case you are bleeding out. Make sure they have a transfer plan that will actually work, make sure they have equipment, a woman recently lost her baby because her incompetent, untrained “midwives” didn’t even have a bulb syringe. Make sure they aren’t just birth junkies who made a slick website lying about their experience. Unfortunately, in some states (Oregon) midwives aren’t required to be licensed so anyone can just proclaim themselves midwives and take on clients. Ask your midwife if she has insurance. If she doesn’t this should be a red flag, it means she is not accountable. If she mishandles your delivery you will have no recourse. A midwife assisted delivery can be a wonderful experience but unfortunately in our country many of them are woefully under-trained, please use discretion and be thorough. And unfortunately if the worst does happen, do not expect support from the birth community, they will rally around the midwife and expect to accept blame.