Choosing a certified nurse-midwife

Choosing a certified nurse-midwife

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What is a certified nurse-midwife?

Certified nurse-midwives (CNMs) provide a full range of primary healthcare services to women in the United States, including routine gynecological checkups, family planning services, preconception care, prenatal and postpartum care, and, of course, delivering babies. They attend births mostly in hospitals, but also in birth centers and private homes.

CNMs are trained in both nursing and midwifery and are certified by the American College of Nurse-Midwives (ACNM). To be certified, a CNM must be formally educated in midwifery through an accredited program affiliated with an institution of higher learning, demonstrate clinical competence, and pass a rigorous national certifying exam. CNMs are licensed to practice in all 50 states, the District of Columbia, and Puerto Rico.

Most midwives in the United States are CNMs. Other midwives are direct-entry midwives, who typically attend home births. They may be certified by the North American Registry of Midwives, and their legal status varies from state to state. A few direct-entry midwives are certified by the ACNM and are called certified midwives (CMs). CMs receive the same midwifery education and training as CNMs, but they are not nurses.

Can anyone choose a CNM to deliver her baby?

You can choose a CNM to care for you during your pregnancy as long as you're in good health (meaning you have no serious chronic medical conditions, such as high blood pressure, epilepsy, heart disease, or diabetes).

At your first visit to a midwife, she'll take a comprehensive medical history, answer any questions you have, perform a physical exam, and have laboratory screenings done. She can make arrangements for any prenatal testing you want to have done that she doesn't do herself, such as ultrasound or amniocentesis.


Find out how a midwife helps a woman through pregnancy, labor, and birth.

If it turns out that you have a medical or obstetrical condition – such as high blood pressure or triplets – that requires the care of an obstetrician or a perinatalogist (a high-risk specialist), she'll refer you to one. In some cases, you'll be able to see a midwife and a doctor.

Why would I choose to see a CNM over an ob-gyn?

Midwives are an appealing option for women who want a more individualized, less routine approach to childbirth than many traditional obstetricians tend to provide. They focus on helping you learn about the physical and emotional changes you go through during pregnancy, teach you how to maintain good health habits, and consider you an active participant in all aspects of your care. They see every pregnancy as a unique event and encourage you to consider your options for labor and delivery and to personalize your own birth plan.

Whatever kind of birth you choose, a CNM will support you in your decision. That said, a CNM won't hesitate to use an intervention if it's necessary for your well-being or your baby's. For example, a midwife will guide you through a nonmedicated labor if that's what you choose, but you'll still have the option of having an epidural during labor (as long as you're giving birth in a hospital). CNMs have obstetricians available for consultation and backup if needed.

Several studies in the United States have shown that healthy women with normal pregnancies who choose CNMs are just as likely as those who choose ob-gyns to have excellent outcomes. And they tend to have fewer medical interventions (including continuous electronic fetal monitoring epidurals, and episiotomies). They're also less likely to have a cesarean section.

Beth, a mother of a 3-year-old boy and a 3-week-old girl in Shutesbury, Massachusetts, used a CNM in a hospital for both of her children's births. "The midwives I used were wonderful – centered, calm, right with me all the way," she says. For her first baby, Beth endured a 30-hour labor and says her midwife, Pam, was by her side the entire time. "Doctors tend to go in and out. Only a midwife would have stayed with me for so long."

For her second delivery, Beth says she didn't see a doctor at any time during labor. "And that was fine," she says. "I felt I was in the hands of very competent people who happened to be midwives. Generally, I wanted a woman-centered approach that saw birth as a natural process and assumed everything would go fine, as opposed to a medical procedure that anticipates problems. A midwife gave me the perspective I wanted."

How does a CNM handle complications?

CNMs are trained to recognize problems that may develop during pregnancy, labor, birth, and the postpartum period. If a complication arises that they can't handle themselves, they have obstetricians they can consult with or call in.

Feel free to ask your midwife about her consulting physician – you may want to meet him or her at some point before your due date. Even if your midwife does need to call in a doctor to help, she'll probably continue to be involved and provide support and care throughout the birth and afterward.

Although Beth wanted to have her first baby at home, she delivered in a hospital because she ended up requiring medical care.

"Still, my midwife was more involved than anyone else," she says. "I was comfortable knowing the doctors were there as a backup, and as it turned out, I needed them. But for the rest of my labor, my midwife took time with me, explained what was happening, and provided the emotional and spiritual support I wanted."

How popular are midwives?

The number of women in the United States whose babies were delivered by midwives increased by 33 percent between 1996 and 2006. In 2006, midwives delivered almost 8 percent of the babies born in this country and more than 11 percent of those born vaginally. (The vast majority of these births were attended by CNMs.)

Midwives are even more common in other parts of the world. In some European countries, midwives are the norm, and obstetricians provide primary care for complicated pregnancies only.

Will my health insurance cover a midwife's services?

Many U.S. insurance plans, including Medicaid, cover CNM services. In fact, Medicaid reimbursement for CNM care is mandatory in all 50 states, and 32 of the states require other insurance plans (including HMOs) that provide coverage for pregnancy to allow women to choose a nurse-midwife as their pregnancy care provider. (Another seven states have laws mandating coverage for "any willing provider" a woman chooses, which would include CNMs.)

How do I find a CNM?

Visit the American College of Nurse-Midwives website for an online practice locator and other information about CNMs. Or call the ACNM at its toll-free number, (888) 643-9433.

If you want to give birth at a specific hospital, call the hospital and ask for the names of midwives who practice there. If you're interested in delivering at a birth center, call the American Association of Birth Centers at (215) 234-8068, or visit the association's website.

Choose your midwife as carefully as you'd choose an OB. Look for someone you feel comfortable with and who communicates well. Ask about her experience, where she practices, how many providers are in her group, who her collaborating physicians are, and which insurance policies reimburse for her services.

If she practices in a hospital, ask about rooming-in with your baby, sibling visitation, and other policies that are important to know when choosing a hospital. If you're interviewing midwives in a group practice, think about what size group you're comfortable with and ask whether all the midwives in the group have the same practice philosophy. See our Midwife Interview Sheet for a more comprehensive list of questions to ask.

Watch the video: Anas Story: The Certified Nurse Midwifery Program at University Medical Center (July 2022).


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