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  • Writer's pictureBrittany Major

Obstetricians vs. Certified Nurse Midwives vs.Certified Professional Midwives

I had the pleasure of getting to work with all three of these professionals during my pregnancy and/or birth. I learned about each of them and thought it would be helpful to share. I know I was wondering what the heck the difference was between them all and I was very confused in the beginning. Depending on who you are and what your goal is, one might be better suited for you and your situation. They all bring different strengths to the table, but how do you know which one is the best fit for you until you know more about each one?

PC: The lovely, Ashley E Photography

Alright, let's break it down.

I think most people are familiar with an OB (or obstetrician). An OB is a medical doctor and has completed 4 years of medical school and 4 + years in a residency program. They typically view childbirth as a medical event and tend to be dependent on technology along with being quick to intervene.

An OB's strengths are in emergencies. An OB is actually who ended up delivering my baby. He had a very calm (and hilarious) demeanor when my birth ended up being very prolonged and not a normal birthツ I appreciated how it felt like just another day to him and he wasn't phased by any of it, at all.

On the other hand, midwifery care tends to view childbirth as a natural event and their strengths lie in understanding birth. They are very steady and know extremely well when something is normal for birth or turning into something that's not normal for birth.

So what's the difference between the midwives?

I obviously have not been trained in either, so I'm just speaking from what I was told and what I saw or experienced. The two that I am familiar with are the ones I mentioned earlier...a Certified Nurse Midwife (CNM) and a Certified Professional Midwife (CPM).

A CNM has a nursing degree and then is later trained in a nurse-midwifery education program. CPMs receive midwifery education from a different governing body and they are the only midwife certification that requires knowledge of, and experience with out of hospital and home births.

Are you wondering what I was wondering? How is the midwifery care different for each one? I wish I could tell you, but since I can't...I will tell you what the CNM from my birth center said. She has many children and delivered babies in both hospitals and at home. She also worked in a hospital for many years and has worked in a birth center for many years. During our interview with her, she told us about some of her experiences and she talked about how she thought she knew everything about birth after her many years of working in a hospital, but once she went with a friend to a home birth, she realized she had much to learn and her life was forever changed.

CNM's tend to work in hospitals and while they may have a more natural approach to birth than OBs, they do also still tend to have the 'medical event' approach. And I often had this question that stayed with me, if birth is a natural event, then why aren't CNMs trained in birth outside of where medical emergencies happen?

It's important to know the two different types and how they differ because you may be looking for a more natural-minded practitioner and end up with one that is not. When we hear "midwife," it's normal for us to think natural-minded, but from my experience, the CPM's have a much greater natural-minded approach.

Of course, every person is different and has had different experiences. That's why it's so important to be aware of the differences and ask questions. I would be 100% comfortable having the CNM from my birth center provide my full care because I know she has had a ton of experience in out of hospital births too.

I was super blessed at my birth center because they had both types of midwives and that was a huge factor in why I picked their care. My goal was always to be as natural as possible and then intervene if needed. It was wonderful to have a CNM because they can typically prescribe prescriptions, if needed, and I appreciate their perspective, which often includes a mixture of both natural care and medical care. And it was also super amazing to have CPMs because they have the most natural-minded approach that I was looking for. I feel like I got the best of both worlds with the understanding that we would not intervene unless necessary and that was how my care went the whole time.

Speaking of prenatal care....they are going to be pretty different with each one. I never received care with an OB, but from what friends and family have shared with me, they tend to go straight to medications first if something is off, they monitor for everything under the sun, and appointments are pretty quick with not much education.

With out of hospital midwifery care, it looks a lot different. The appointments typically last around an hour with a couple minutes checking your blood pressure and heart rate, and the rest of the appointment is spent educating you and giving you time to ask lots of questions. When something is off, they have a list of natural options to try first. Something to keep in mind is that the state laws vary and some will require you to transfer care to a hospital.

Here is some great information from my birth center's website if you want to know more about midwifery care:

  • Is an out-of-hospital birth safe? The health of the mother, comprehensive prenatal visits, risk screening, referral, and/or transfer to the hospital when appropriate, and continuous support and care during labor and birth are what make birthing with New Beginnings safe. Out-of-hospital birth (at the birth center or in your own home) is as safe as, or safer than, hospital birth for the majority of women. We also offer VBAC (Vaginal Birth After Cesarean) when screening determines low risk. The Midwife Alliance of North America has several studies, articles, and printouts that you can share with your family and friends.

  • How can a birth center have such good outcomes? We provide complimentary screening for safe birth services to determine high-risk women or babies. The majority of women are good candidates for out-of-hospital birth. Furthermore, we do not perform services that increase your risk for complications such as using continuous fetal monitoring or prescription pain medications. Holistic care begins with your first visit and continues throughout your pregnancy with one-on-one care. Our focus is on the prevention of problems through nutritional support, exercise, and utilizing homeopathic resources. Birth, breastfeeding, and recovery are all better when the woman is prepared, confident, and well-supported!

  • What happens if birth doesn’t go as planned? Although out-of-hospital birth is statistically safer, it does not guarantee a complication-free birth. We are highly skilled and trained to detect and manage most birth complications. We have all the necessary medical equipment and supplies, which preserves our capability to safely deliver out of the hospital. We discreetly tucked away all necessary equipment such as oxygen, IV therapy, and medications, and they are available for use whenever needed. Deviations from normal that should not be managed out of the hospital often have early warning signs which permit ample time to transport to the nearby hospitals. In this rare instance that transportation does become necessary, we have working relationships with many of the area hospitals and physicians and we will continue to be an active helper in your care until the birth of your baby and beyond.

Once again, these are just what's typical and what I have observed, but every professional and every place is going to be different. Ask God to guide you, ask questions, go with what feels best, and hey, you can always change your mind too...I give you full permission ツ

Much love,

Brittany ♡

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