Certified Professional Midwives
The Role of a CPM
A Certified Professional Midwife (CPM) is a maternity care provider who specializes in normal pregnancy and natural birth. Her job is to help prepare a woman and her baby for a safe and healthy home or birth center birth.
A CPM is educated through both thorough classroom study and extensive apprenticeships in which she works with an experienced midwife practicing prenatal care and going to births so that, by the time she is certified, she will have both studied and seen many different kinds of pregnancies and births. No other provider is required to have experience in out of hospital birth — CPMs are the experts here.
What Makes a Certified Professional Midwife Different?
Compared to other maternity options like a Certified Nurse Midwife (CNM) or an obstetrician, CPMs have significantly lower intervention rates. They do not have a nursing degree like a CNM or a medical degree like an obstetrician (Why learn geriatrics or oncology if you are in obstetrics?). They are specialists in normal pregnancy and birth and know when a client needs referral to an obstetrician or pediatrician. They currently practice exclusively within a home birth or birth center setting, but will attend to you at the hospital as a support person or doula if a transfer becomes necessary. You will be received at the hospital by the doctor "on call".
You may not find a CPM on your insurance company lists of covered providers, but many insurance plans do cover out of network providers. Often your policy co-pays for a hospital birth will add up to the entire fee for a CPM. Most CPMs charge significantly less than other care providers and your bill will not have the additional costs of the hospital, cesarean section or anesthesia expenses. You may have to pay their fee prior to your birth out of pocket but most will take credit cards or have options for payment.
Midwives and Maternity Care
Prenatal Care
A prenatal visit with a CPM can be very different from an obstetrician or a CNM. A visit with a CPM lasts significantly longer, up to an hour in some cases. Towards the end of pregnancy, they may even be in your home. Your urine will be checked for protein, your weight taken, blood pressure checked and belly palpated for the baby’s position. The baby’s heart rate will be checked with a fetoscope or Doppler device. Initial blood tests and ultrasounds will be done if necessary and blood sugar levels will be checked later in pregnancy. Other children are welcomed and even encouraged to participate, “helping” to check the blood pressure, palpating the belly, etc. All of this is done is a setting that feels and may actually be closer to a bedroom than an exam room.
Labor
During labor, the CPM will assist the mother in coping with her contractions, encouraging her to stay relaxed, helping her to find the most comfortable position for delivery and guiding her through the birth of her baby. Many CPMs use large birthing pools as a comfort tool. Unlike a hospital labor and delivery, a mother birthing with a CPM will not be pressured to induce her labor, augment or speed up her labor with drugs, or be offered chemical pain relief unless she wants to transfer care to a hospital. A CPM will treat labor as a normal and healthy process unless it proves otherwise.
After Delivery
After the birth, a CPM will allow mother and baby the time they need to be close. She will make sure the placenta is delivered and check the mother for tears and repair if needed. After the cord has stopped pulsing, it will be clamped and cut and the baby will be encouraged to breastfeed. She will also do a thorough newborn exam to include length, weight, head circumference, sucking reflex and respiration. All of this will be done in the same room so that mother and baby are never separated.
Evidence-Based Care
Most important are the things a CPM will not do. CPMs strive to practice evidence-based care. That means they will not do something unless it has been scientifically proven to be beneficial and safe to the mother and baby. For this reason, they do not induce labor unless medically indicated, they don’t deny food to a mother in labor, and they don’t cut an episiotomy, as these have been proven to be damaging to the mother and unhelpful to the birthing process. Those three examples are just some of the evidence-based care that you will find with a CPM, while other care providers may do otherwise because of hospital policies.
Choosing the person to attend you at the birth of your baby is a big decision to make. If you are looking for a natural childbirth experience, it can be difficult to find providers who are willing and able to accommodate that due to hospital policy, insurance regulation and a myriad of other factors that have very little to do with your health and that of your baby. A CPM is a safe and viable option for anyone looking for a natural and beautiful birth experience.