Written by Erin Odom, Contributing Writer
If you're expecting a baby (or hope to sometime in the future)--especially for the first time--your mind is probably spinning with questions. What supplements should you take? Should you exercise while pregnant? What's the best pregnancy diet? And, of utmost importance, who should oversee your prenatal care and ultimately deliver your baby? Should you see an OB or midwife? And how do you find a birth provider that works for you?
These are questions no one should take lightly. But the last question I didn't even think about during my first pregnancy. Even though it was 2008, I didn't even know I had a choice besides using an obstetrician for my prenatal care and delivery. Since then, I've learned about Certified Nurse Midwives (CNMs) and Certified Professional Midwives (CPMs).*
Not all may be options in your state of residence (Obstetricians and CNMs are the only ones legally able to practice where I currently reside--North Carolina), but it's wise to be aware of all your options before making a final decision.
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Obstetricians are doctors. They have completed medical school, where they were trained to provide care for women during pregnancy, labor and post-labor. Most obstetricians are also trained to be gynecologists, with many possible areas of expertise, such as reproductive cancers or infertility. They are also trained as surgeons and are the only care providers who can perform C-sections (source).
Reasons to use an OB
- You are a high-risk pregnancy. High risk does not necessarily include such conditions as gestational diabetes (I had it during my second pregnancy and used a CNM.), multiple babies or some other minor complications. High risk includes chronic, serious illnesses on the part of the mother or baby.
- You feel most comfortable in a hospital setting. (That I know of, there are no OBs who practice in homes.)
- You will require a C-section.
- It's your only option. Even though I had no idea midwives still practiced when I had my first baby, I have since learned that, for where we were living at the time, an OB may have been my only option anyway. There are some areas where midwives are not available.
Certified Nurse Midwives (CNMs)
CNMs are essentially registered nurses who have received extra training to equip them to perform all of the same tasks as an obstetrician, except C-sections (source). I have used a CNM for both my second and current pregnancies. A CNM often practices in the same office as an obstetrician, and if an emergency arises (during pregnancy or labor/delivery), the obstetrician can back up the CNM and take over care if needed.
Where I receive my prenatal care, there are a handful of OBs and three midwives. I primarily see one midwife (who delivered my second baby), but any of the three could potentially deliver my baby--depending on who is on call at the hospital on that day.
The biggest difference I have seen is that CNMs are oftentimes more naturally-minded. They are accustomed to their clients preferring no or minimal interventions.
CNMs also spend more time getting to know their clients. My midwife feels like a friend. Instead of 5 or 10 minutes per prenatal visit (like I experienced when I used an OB during my first pregnancy), my midwife spends an average of 30-45 minutes with me per visit. Not only does she check my measurements and inquire about any difficulties, but we simply talk about life and get to know each other. This helps facilitate a mutual respect during labor. Also, my OB only entered the room when it was time for me to push during my first labor, but my midwife was there for the entirety of my time at the hospital (although she didn't hover--and gave me privacy if I needed it!).
Reasons to use a CNM
- You are a low-risk pregnancy but still want to deliver in a hospital (although some CNMs also deliver in birthing centers or even in homes).
- You desire a natural birth.
- You desire to get to know your birthing professional. You prefer to be a name instead of a number.
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Certified Professional Midwives (CPMs)
CPMs are skilled birthing professionals who are certified by the North American Registry of Midwives (source). They are able to perform all the same care as CNMs, but only practice in birthing centers or in homes. They are not required to obtain nursing degrees, although some CPMs do obtain both CPM and CNM status.
Many women who choose homebirth prefer the care of CPMs because their training includes an extensive amount of time attending home births. In fact, in order to become certified, they must attend a minimum of 20 births--10 of which must be in an out-of-hospital setting (source). Although CNMs can legally (in some states) deliver in homes, their training does not require the extensive out-of-hospital experiences.
Reason to Use a CPM:
- You are a low-risk pregnancy.
- You desire a homebirth or birthing center birth.
- You desire a natural birth.
- You desire to get to know your birthing professional on a more personal level.
Image by eyeliam
A Word about Doulas
I had never even heard of a doula until after my first child was born! A doula cannot deliver a baby or give prenatal care, but she is still a birth professional. The word "doula" literally means "a woman who serves." A doula can serve as both an emotional and physical support to a woman before, during and after labor. Read more about doulas at DONA International.
*There are many different types of midwives beyond just CNMs and CPMs. This post is meant to give you a snapshot of some of the more common North American birthing professionals. For more information on midwives, visit the Midwives Alliance of North America.