There are two types of midwives recognized in America: a Certified
Nurse Midwife (CNM) and a Certified Professional Midwife (CPM).
Certified Nurse Midwives are registered nurses who have completed
postgraduate training accredited by the American College of Nurse-
Midwives (ACNM). The majority of CNM’s work in a hospital or birth
center under the supervision of a physician, tend to follow the
medical model of care, and are restricted by the guidelines of their
affiliated workplace.
The second type of midwife is the Certified Professional Midwife
(CPM) who is certified by the North American Registry of Midwives
(NARM). NARM requires apprenticeship, rigorous exam, and an 8-
hour written exam. CPM’s are licensed by the state of Tennessee.
CPM clients consist of low risk, normal and natural births. Most
midwives conduct their prenatal visits as follows: once-a-month until
the 32nd week of pregnancy, once every-other-week for 32nd to
36th week, and then once-a-week until birth. CPM’s spend up to 11/2
hours per prenatal visit, covering all aspects of care. Most use
natural, herbal and holistic remedies for common complaints of
pregnancy. With both types of midwives prenatal visits include blood
pressure check, fetal palpation (position) and heart tones, urine dip
stick test, and Fundus (top of uterus) height check. However, unlike
prenatal visits done by nurse-midwives, CPM prenatal visits are
conducted in the mother’s or midwife’s home. There’ is no hurry.
The commotion of a hospital or birth center is nonexistent, allowing
the mother to enjoy a relaxed atmosphere where she gains ample
time to bond with her caregiver.
CPM’s believe that pregnancy and birth are a natural state, not a
pathology or potential disaster to be controlled. Women know their
body’s best, therefore a CPM depends on the client for information
about her own well being. CPM’s know that the birth process is never
the same, even with the same mother and cannot be regulated by an
arbitrary time table, but must be allowed to progress in its own
natural manner. Most CPM’s trust the birth process and are as non-
interventive as possible. CPM’s have the lowest rate of episiotomies,
damage to the perineum, vacuum-extraction, forceps delivery,
vaginal infections or C-sections. In addition CPM’s are highly trained
to recognize and handle normal birth complications without use of
invasive procedures.
There are many advantages to having a home birth, not the least of
which is that the laboring woman enjoys the indescribable comfort of
her own home. In the home, mother and newborn are exposed to
less foreign pathogens. Many women deliver their babies on the
same bed in which they were conceived. A woman who labors at
home can choose to have family members and friends for caregivers
and labor support and is not hampered by monitors or IV’s and is
free to move around, change positions, take a walk outside, relax or
even give birth in the bathtub. In addition, the rate of surgery (C-
section) among CPM clients is so low that eating and drinking during
labor is not an issue and are allowed to eat what they like to
maintain their energy for the hard work before them. The mother is
not required to jump into her car in the throws of labor and ride to a
birth center or a hospital. Babies born at home are more alert and
are ready to nurse within minutes of birth, which helps with the
tightening of the mother’s uterus (minimizing bleeding).
For the healthy, low risk mother the advantages of a home birth as
well as the most meaningful aspects of the mother/midwife
relationship are innumerable. In developed countries, research has
proven midwife-attended homebirth to be just as safe as hospital
birth.
By Lisa Coomer, CPM-TN
Midwife or Nurse?
