Birth: Finding a Midwife

The hunt for a midwife has been long and difficult. From what I understand, when most women are pregnant they talk to their girlfriends and find out who people liked, find out if the provider is covered by their insurance, and begin their prenatal care. I’ve found the search for the right midwife to be much more involved than that.

In my search, I’m considering two different types of midwives. One is known as a Certified Nurse Midwife (CNM) and the other a Certified Professional Midwife (CPM). I’ve searched around for what I consider to be an unbiased opinion about the difference between the two types, and I really like this PDF provided by the website Safe Birth Ohio.

Safe Birth Ohio describes a person with the credential CNM or CPM has earned a nationally recognized credential. CNMs are required to have a nursing background. CNMs practice primarily in hospitals. CPMs practice primarily in out-of-hospital settings.

According to the American College of Nurse Midwives, CNMs are registered nurses who have graduated from a nurse-midwifery education program accredited by the Accreditation Commission for Midwifery Education (ACME) (formerly the American College of Nurse-Midwives (ACNM) Division of Accreditation (DOA)) and have passed a national certification examination to receive the professional designation of certified nurse-midwife. Nurse-midwives have been practicing in the U.S. since the 1920s. To learn more about what it takes to become a CNM, click here.

According to The North American Registry of Midwives, a Certified Professional Midwife (CPM) is a knowledgeable, skilled professional midwife who has been educated through a variety of routes. Candidates eligible to apply for the Certified Professional Midwife (CPM) credential include:

  • Graduates of programs accredited by the Midwifery Education Accreditation Council (MEAC);
  • Midwives certified by the ACNM Certification Council (ACC), Inc. as CNMs or CMs; and
  • Candidates who have completed NARM’s competency-based Portfolio Evaluation Process, the PEP Program.

An excellent PDF about CPMs and the training they receive can be found here.

I believe that comfort plays a huge right in determining who the right care giver is for each person, and I am personally comfortable with both CPM and CNMs. That Husband and I had a very large incentive to seek out a Certified Nurse Midwife as our insurance provider would likely cover 80% of the costs, a difference that would mean thousands of dollars. Our insurance (BCBS), as well as most other insurance companies, offer out of network coverage for home/birth center births done with CNMs, but absolutely nothing for home/birth center births done with Certified Professional Midwivess. Based on the Dallas averages we knew would be looking at paying somewhere around $1500 for prenatal care, tests, and birth with a CNM, but that the cost with a CPM would be somewhere between $3500-$4000.  (Yeah, I’m choking on that number as well.)

Unfortunately CNMs that do out of hospital birth (and in case you missed it, I wrote about why I want an out of hospital birth here) are difficult to find and there aren’t very many of them. The home birth CNM who came most highly recommended to me by some women in my church didn’t have any availability for April by the time I contacted her.

Once I had a baseline understanding of the pregnancy and labor process I felt ready to start interviewing potential caregivers to find the right fit. I sent out a list of 12 questions to midwives I found through a website (I’m sorry, I can’t remember what it was, although I did later find this fantastic list on the American Texas Midwives page), and then responded back to those who answered my questions in ways that showed our opinions on things were similar.

I consulted with three different midwives in person before making my final choice. Below you will find the list of questions I took with me to my last appointment (with a CNM). Please note that although I referred to other lists found across the internet to make sure I wasn’t missing anything, this list represents my actual concerns, not just questions someone else said I should ask. Do your research (surprise!) and know what terms mean, risks, alternative options, etc. The only person looking for for your own best interest is you, and you shouldn’t be choosing someone for a task as important as delivery your baby based on whether you liked their personality or not.

My questions:

How many births have you attended as a primary caregiver?
How many births do you attend per month?
How long is the average prenatal appointment?
Do you let us do whatever we want during labor? (Food, positions, water, privacy for intimate time with my husband, etc.)
Do you have guidelines or restrictions about who can give birth at home?
Non-emergency transfer rate?
If I transfer, how long will you stay with me at the hospital?
C-Section Rate?
Episiotomy rate?
Do you attend breech births?
Augmentations used to intitiate or during labor?
Do you wait until the cord has stopped pulsating before it gets cut?
How much time do you allow for the delivery of the placenta? What methods do you use to encourage delivery of the placenta if there is a delay?
How many attendants will be at the birth?
How long do you stay after the birth? What cleanup do you do?
Belief about postdates?
What are your guidelines concerning weight gain, nutrition, prenatal vitamins, and exercise? What are your standards for pre-eclampsia?
Do you provide nutritional counseling?
Opinion on gestational diabetes?
Require any tests?
Have you ever had to resuscitate a baby?
Experience with mothers who have had a breast reduction?
Experience with hypnobabies?
Does the birthing center provide birth/breastfeeding classes?
Postpartum visit after birth?
What organizations do you belong to?
Do those organizations have any requirements that you must follow in relation to my care?

That Husband sent me with a few questions of his own. He couldn’t attend this consultation with me because he had to work.

1. What are the most common complications during home/birth center birth?
2. How do you handle each of these complications? Is there an additional risk of having the birth at home vs. birth center?
3. What drugs/instruments do you bring with you to a home birth? Are there any drugs/instruments that would be available at a birth center birth that won’t be available at a home birth?
4. Which birth complications is a CNM better prepared to handle than a CPM?

After many, many, many conversations with That Husband (and several instances of me changing my mind back and forth based on guilt about the cost), we decided on a really wonderful CPM with both the personality and the belief system about birth that will serve our needs. I want to make sure I have her express permission to write about her on the blog so I won’t be telling you more about her until then!

I know many of you are curious about what care with a midwife is like, and so I plan on writing about my prenatal appointments (I’ll show you some photos of the birth center where I have them, it’s gorgeous!), the tests I choose to submit to (and why I’m not taking some), and what my overall experience is like. I’m not going to do many ultrasounds, but I am going to have one done at 20 weeks, which is only three weeks away!

36 thoughts on “Birth: Finding a Midwife

  1. You must be very excited about your ultrasound, I know I was! Where I live in Canada, they only give you one ultrasound at 19 weeks. That’s it! My US friends are shocked that is all I got for my entire pregnancy, but it was all I needed. It is such a wonderful thing to see your little baby moving around on the screen though :)

    Sophia Reply:

    Mags, they’re shocked that you have to suffer under the harassment and torture that is socialized medicine. Ya know, I’ve heard stories of pregnant women comin’ to America just to get the ultrasounds that they are denied in their native land! ;) (tongue firmly in cheek here of course)

    Ariel Reply:

    I had good insurance and that’s all that was covered through mine in the U.S.
    Here is the blog of a Canadian friend due in three weeks. Her view is a bit different and honestly? I’d totally trade her.
    http://www.assertagirl.com/?p=1287

    Mags Reply:

    Interesting blog entry. I am actually from the US but moved here with my husband about three years ago and am currently 37 weeks pregnant. I know the hospital does provide all the newborn essentials (never heard of bringing your own diapers?!) but we are opting for a private room which is an extra $15 a night! So far my experience with the Canadian healthcare system has been pretty positive but I’ll know more once I actually experience delivery in a hopstial setting! Eeek!

    Ariel Reply:

    I actually only meant to link to the blog, not that particular post but ya, let us know! And best of luck!

    Sophia Reply:

    Just to be clear, I was poking a little fun at the people terrified by socialized health care- I have tons of friends all over the world, I lived and worked in Japan, and every experience I and they have had with socialized health insurance has been good. I just couldn’t resist being a little sarcastic in the morning :)

    Evelyn Reply:

    You know the funniest thing about ultrasound is that one u/s is all that is really necessary. We have a tendency to over do it in the US and then become reliant on it… which is a major problem now. Doctors here think you NeeD to have three, or at LeasT two! Imagine what happens when you tell them you don’t want ANY…! And even with research from medical journals to back you up it’s still a fight! I can’t say that I’m a fan of socialized medicine, because I have friends who’ve had very bad experiences with it, but seriously, it does cut down on some of the unnecessary expenses, habits, procedures, etc.

  2. We need another belly picture!!!! hahaha

    Cate Subrosa Reply:

    I agree! 17 weeks already… let’s see you! :)

    Jenna Reply:

    Cate I’m not a skinny mini like you, so I don’t just have a huge bump right now, I just have a big fatty looking belly. I’m ready to “pop” and being stubborn and not showing belly pictures until that happens. :)

  3. I was very lucky- I chose my midwife merely on word of mouth from other people. I felt bad thinking about doing an “interview” and then turning someone down. So, while I asked some general questions about which hospital I would be transferred to if the need came up, etc., I called, made an appointment, and she was my midwife. And even though our personalities didn’t really click (it’s not like we didn’t get along, we just weren’t best friends- she was my capable caregiver and I was her capable client), I was thoroughly blessed to have her- she was a CNM who operated solely out of hospital, she had access to ultrasounds, and she was very non-intervention-minded. Since I have read up on the differences between CNMs and CPMs, I now realized how spoiled I was to find a CNM who operated out of the hospital and was fine with letting me just labor naturally, however I wanted. Not that I would have minded having a CPM, but I’m glad I got a CNM who wasn’t like a lot of hospital-based CNMs.
    Just an example: when I had been in labor approximately 20 hours, she offered me a narcotics shot to take the edge off of the contractions and give the chance to sleep a little (I’d been laboring all night and half the next day at that point). I refused it at that point, but several hours later, after not progressing much further, I voiced to her my concern that I would be too tired to push once the the time came (I had heard this excuse from doctors of friends of mine and I wasn’t sure if it held any water). She emphatically told me, “No, you’re gonna be fine! When you get to pushing stage you’re going to have more than enough energy!” And that was that. And she was totally right! Now that I’ve been through it, I honestly don’t know how women can think they “were too tired to push.” But that’s a whole separate subject. ;)
    Anyways, but I’m so glad you found a midwife that you’re comfortable with- it makes all the difference in the world!

    Ariel Reply:

    You can absolutely be “too tired to push” because after hours and hours of contractions and shaking and throwing up and then hours of pushing I had literally NOTHING left. I was too tired to push.

    Regina Lynn Reply:

    Ok, I’m sorry. Guess I shouldn’t have said that being too tired is never the case. I suppose there are cases, but not near as often as doctors and nurses tell mothers, “Aw, we’ll just give you the epidural (c-section, IV drugs, etc.) so you won’t be so tired when it comes time to push.
    For myself, I was in labor for 26 hours before I hit pushing stage. Over 6 hours in transition, with contractions so intense I was beginning to black out. I all but threw up, getting that nasty pre-puke feeling and retching. I was shaking pretty much anytime I stood up or walked around during my transition. Trust me, I know what it feels like to think you’re too tired to push- until that first strong urge to push came and then there was no holding back.

    Ariel Reply:

    I understand what you meant though- I was good for 3 hours of pushing- but I did reach the point where I had nothing left.

    Ariel Reply:

    Honestly I think the shaking was the WORST part! I hated it! I never shaking from about 2 hours in until it was done.

    Ariel Reply:

    Oops, that’s supposed to be STOPPED shaking:)

    Regina Lynn Reply:

    No, no, I can fully understand why, after that amount of time spent pushing, someone would be, literally, pooped. In my original comment, I was more referring to hospital births and women who claim, after 12 hours of labor, before they ever GOT to pushing stage, that they were too tired to push. Not that I blame mothers- epidural pushing nurses are very good at convincing women in transition that they “need” it so they’ll be able to push later. Whatever…

  4. Great post! I am so glad you decided to write about your prenatal care. Those were great questions you asked the midwives you interviewed. I’m so excited for your 20-week ultrasound!!!! And I agree — we need another belly pic.

  5. Ooo! I can’t wait for more details. What an exciting process! That’s such a good idea to send out letters with questions and see who responds. It’s a good way to see how much time they want to devote to you and get your questions answered at the same time.

  6. TW, thanks for sharing, because you really didn’t have to. I certainly would have have been reluctant after all the hyper-critical people kept jumping and blowing your comments out of proportion.
    Finding a care provider for something as sacred & personal an event as pregnancy and birthing is unique to every parent-to-be. No circumstance leading to the decision is the same.
    Every mother’s journey deserves to be nurtured, safe, and respected.
    Regardless of the price of the birth, I think the whole event is priceless in itself. If there is one thing in our life that we should hold most sacred, it’s definitely this.
    I can’t wait to see future posts on your journey! Wishing you & TH joy and warmth in the weeks to come!

    Kait (Kaitlyn) Reply:

    All I can say is I second this comment!

  7. I’m glad you were successful in your search! I’m sure you feel reassured to have a midwife who supports you in your plan and is capable of helping you achieve it! Congrats!

    And I am glad you shared the information you did as well as how you went about your search. There have been a number of comments in the past with a variety of questions and doubts about midwives, and it seems clear from what you wrote that you were well educated, prepared, and able to ask the right questions to find a midwife that is educated, experienced, and capable to perform her job.

  8. I couldn’t get the PDF to work…was it just my computer? Thanks for the help!

    Melissa Reply:

    Sorry, I wasn’t very specific…the one from Safe Birth Ohio.

    Jenna Reply:

    I didn’t insert the link correctly! Try this:

    http://www.safebirthohio.org/compare.pdf

    P.S.-It’s nice to know that people are actually trying to read things that I link to!

  9. Not really related to this topic, but will you be sharing your thoughts and/or research on circumcision if you do have a baby boy? It something that mine own family has 2 different opinions about so I would love to read any research you’ve done on the topic!

    And I forgot, will you be finding out if you are having a boy or girl and sharing that info before that baby is born?

    Jenna Reply:

    I added it to my list of topics to cover!

    We won’t be, although it’s definitely an interesting dynamic between the two of us (husband and I). It’s also kind of hard to discuss publicly because it’s a bit person, you know what I mean? I’ll see if I can come up with a post that TH feels okay about though!

    We aren’t finding out (so we won’t be sharing!). I want it to be a birthday surprise (the baby is due just a few days before my birthday!)

    Lillindy Reply:

    Great, I so look forward to a post that TH would feel comfortable sharing! That will be a great birthday surprise. When in your birthday? Mine is April 15th!

    JessicaMayBe Reply:

    OHH I find the circumcision argument very interesting! One of our friends who was very close to delivering was adamantly against it, and it became this huge topic of conversation where at least 8 people in the room had very strong opinions on it… I just said “yeah, I’d circumcise my kid… I want him to look like his dad.” But I know it goes far beyond that for many parents. Most of my friends looked at me like I just told them I was going to stab my kid in the heart, not circumcise…. an interesting topic for sure.

    phruphru Reply:

    A topic I am really interested in, too. If we have a boy, we will not circumcise. Neither DH nor I grew up in cultures were circumcission was the norm. My sister, however, married an American guy and she has openly told me she thinks the idea of not circumcising is “disgusting” and my nonexistent kid will get beat up in the locker room. Looking forward to hearing more logical arguments about not circumcising so I can keep it under my belt for when it’s my turn!

    JessicaMayBe Reply:

    I’ve heard a lot of the OTHER arguments including:

    non-circumcised men have more intense orgasms
    it’s painful
    it’s unnecessary
    it’s not necessarily cleaner
    the glans has more feeling as the head of the penis hasn’t been as exposed to underwear, jeans, etc.

    Those are the arguments I’ve heard. Honestly, I don’t think non-circumcised penises are as aestheically pleasing, but I’ve only seen non-circumcised pictures, so, there you go. :)

    I know this is an awkward topic…. sorry Jenna if that was weird to leave! Eak!

    Katherine (a.k.a. Sparkles) Reply:

    The American Academy of Pediatrics basically leaves it up to the parents decision as to whether or not they want to circumcise. HOWEVER, regardless of what ANYONE SAYS there is data supporting that non-circumcised males have a greater incidence of UTI (which can lead to sepsis/infections in children) and STD’s (and a small fraction prevalence of penile cancer…). And yes this is attributable to poor hygiene practices and can be avoided with good habits. But frankly, if hygiene practices were good- then this data wouldn’t be out there. Speaking from personal experience as a Pediatric Registered Nurse- I cannot even begin to tell you how many parents with baby boys and older have issues with cleanliness of the un-circumcised male… part. Obviously, as the boy grows up they grow out of it (I can only assume, since they are taking on more self-cares, then again when I was doing rotations with dermatologist and I had to round with him on adult patients I saw some REALLY un-hygienic man-parts)… but it is an issue of education, re-education, and reinforcement of proper hygiene.

    JessicaMayBe Reply:

    BLECH, you’ve convinced me. ::shivers::

    Kelli Nicole Reply:

    One thing that is probably a huge problem in those boys is that they’re actually retracting to clean (which is very very bad and causes infections and goop and all sorts of problems). A boy with an intact penis who’s not retractable yet should NOT have his foreskin pulled back to clean, it’s fused to the glans for a reason and it just needs to be wiped like a finger to be kept clean (way easier than girls or circ’d boys!). An intact penis is far easier to keep clean as a newborn especially, as a circumcised penis is essentially an open, bloody wound exposed daily to urine and poop. Boys become retractable anytime from birth to age 18, usually happening around the start of puberty (I asked one of my friends about it and he said for him it happened around age 10 and he has NEVER had cleanliness issues).

    Here’s some good Canadian information :). http://www.cps.ca/caringforkids/pregnancy&babies/Circumcision.htm

  10. Thank you so much for this very comprehensive post! I will have to save it for later when I am looking for my own midwife (hoipefully someday in late 2010 / early 2011 – fingers crossed!)

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