Midwifery Model of Care: CPM vs. CNM (My Experience) | Mother Rising
Because of my recent miscarriages and my MTHFR diagnosis, I chose to do my prenatal care for my current pregnancy in an OBGYN's office. I wanted to have easy access to testing, prescriptions, ultrasounds, etc., if I needed it, but also access to the midwifery model of care.
I love the Midwifery Model of Care
Through the midwifery model of care women have access to care designed just for her and her pregnancy. For example, when a woman is low risk she will stay with a low intervention midwife, but if she needs more help and interventions she would use an OBGYN, or even better, collaborative care from a midwife and an OBGYN.
My Experience
(The following is the story of my experience with the midwifery model of care with a hospital CNM. Unfortunately, it wasn't the experience I was hoping for. Thankfully, there are awesome care providers out there, no matter what their credentials. Nevertheless, this was my experience.)
Right now I am using a certified nurse midwife (CNM) through my OBGYN's office. She is great! As a doula I have attended a birth with her and she was very supportive of mom's wishes, very hands off and laid back. My kind of midwife!
If I had to have a hospital birth, I would absolutely want her there and I would be worried if she weren't! Despite my love for her and her birth greatness, I confess I am very disappointed in the midwifery care I have thus far received.
I'm Disappointed
You see, with my son's pregnancy I was using a certified professional midwife (CPM) at a freestanding birth center that also attended homebirths. I experienced what true midwifery care was and I'm sorry to report that so far (i'm almost 18 weeks) the prenatal care dulls in comparision.
One of the biggest differences in care I have experienced is the lack of a developing relationship. Really, the only way you develop relationships is by spending time with one another, and sadly I have spent more time getting to know waiting rooms than my actual midwife.
CPM vs. CNM
The first appointment I had with my CPM with my son's pregnancy was an hour and a half and all that time was spent with the midwife. My initial appointment with my current pregnancy was a similar amount of time but spent maybe 20 minutes with the actual midwife. The rest of the time was waiting, doing initial bloodwork with a nurse, etc.
One time I asked my current midwife (CNM) if she could tell if my uterus had flipped forward, and instead of feeling in my abdomen and touching me she simply stated that there was no way to tell. The heck?
My CPM's have always been able to tell if my uterus seemed smaller than normal because it was simply facing my back and not forward.
Prenatal Nutrition CPM vs. CNM
Another huge difference in my care is the lack of attention to nutrition. No joke, my out of hospital midwives are serious sticklers for good nutrition. They will give you a nutrition assessment and continue to ask about it throughout your pregnancy.
CPM's are not trying to be controlling, but simply trying to keep their clients low-risk. Good nutrition keeps moms and babies healthy and helps prevent complications.
Once a CPM's client starts developing complications, she could easily risk out of her care and have to transfer to the hospital.
It's a win-win! CPM's keep their clients, moms and babies stay healthy. Seems like a DUH sort of thing to me.
Apparently, it's Not a DUH Thing
I have had zero conversations with my CNM about nutrition. Nothin. Nada. And this makes me VERY sad.
Ladies, you have GREAT influence over the health of your pregnancy and your baby... and that is done with good prenatal care and excellent nutrition! For example, did you know that the intake of probiotics in pregnancy is associated with a reduced risk of preeclampsia?
It's not as simple as "your baby will take the nutrients from you that it needs to grow and be healthy". Yes that's true, but wouldn't you like to lower your risk of preeclampsia (bed rest, feeling like crap, inductions, etc.) among other things with good nutrition?
Broken System
Our maternity healthcare system is BROKEN! I am currently experiencing the broken system and I am very sad.
Do your research, get the dirty details on your care provider, and be your own advocate... especially if you're planning for a hospital birth or not using the midwifery model of care.
Remember, you can always get a new care provider. It's never too late!
LOVE this. Love it. Right there with ya.
I completely agree. That is why I chose a CPM for my last pregnancy. I truly value the time and attention the CPMs gave me.
I have anemia with my pregnancies. I remembet Layla calling me about my prenatal labs. I assumed she would just tell me to take iron supplements like my CNMs did. She completely surprised me! We spent several minutes on the phone discussing my diet & how to improve my iron intake. I never did have to take iron!
Sorry you're unhappy with your midwife! I do know the feeling as I started off my first pregnancy all the way up to 27 weeks with a regular OBGYN's office. OMG talk about lack of relationship! I had a different doc every single appointment. Spent 10 minutes tops in the room with someone who shrugged off every question I had and literally walked for the door as I was still trying to talk. HORRIBLE!!! Thank GOD I found my homebirth midwife in time!
I have a CNM and a CPM that work together. They both attend the birth and I have appointments with each of them. I wonder if the problem with your CNM is more that she works in the environment of an OBGYN's office? I see most of those "hospital midwives" as not much different from regular nurses. They're taught by the broken system to work in the broken system. My CNM is wonderful and has been practicing for over 30 years. So I'm thinking maybe it's more an issue of where and whom they work with. I hope???
True!
Great post!
Preach it, Lindsey! My first experience with a CPM and my homebirth was so awesome. I'd never had my primary provider actually, you know, TOUCH ME. And at every appointment she asked "what did you have for breakfast?". And then we'd discuss my food choices. It was an incredible experience, so much different and better than my 4 previous OBGYN experiences.
Highlighting the vast differences in how midwives practice depending on their location IS yet another example of how broken the system is. The out-of-hospital experience works to empower the woman by giving her ownership over her pregnancy and birthing experience, while the in-hospital experience spends its time working to make sure the woman is a good patient. And I had not read that study about probiotics. Thank you for sharing.
Great post!
You can not attribute one Experience with a CNM and group them all together! It could simply be a personality conflict, or the way this ONE CNM practices, but to lump them all together is not a fair judgement. I am a CNM and I spend 1 hour with all new patients and then 1/2 hour appointments there after. We discuss nutrition, baby, family, support, and their body at each appointment. Titles in my opinion do not matter. It is about the person treating you, their passion, compassion, and knowledge of the field that makes them a good clinician!
I completely agree! Thanks for your comment and sharing your experience as well. It's exciting to hear how you care for your patients. I'm so grateful!
I am a CNM who practices the way you describe your CPM experience. This is not about the letters behind your name, it’s about a practice model. Your observations of two individual providers to not encompass all people with those credentials. It’s overly generalizing and polarizing - please rethink.
Thanks, Cindi, for your comment. I appreciate your perspective and am so pleased to hear the quality of care you bring to women in your community. I stand corrected!
I don’t disagree with there being different model of care between a collaborative hospital practice and an out of hospital (OOH) practice. However, I do take offense to CNM vs CPM because, the care that you described you received when we’re OOH from a CPM is my standard of care as a CNM. I’m an OOH CNM and I learned this standard from being in a birth center setting with only CNMs. I have now started a home based practice and this is the standard that I took into my practice. I’m also an interim clinical director at a birth center and those are the standards that we practice as well.
It is offensive to me that a doula (yes, I’m familiar with doulas, i truly appreciate the job they do) would be so uninformed and so insulting. Especially to a profession that works so hard to recommend and support the work of doulas.
I appreciate you setting me straight and I apologize for offending you! I'm happy to hear that my experience isn't the experience in other places. That makes me very happy.
I also want to add that I’m sorry you CNM experience left you desiring more. The Collaborative CNMs that I know and have worked with strive to have midwifery model of care vs a medical model. Not all but most, just as some physicians that work with are very hands off and allow clients to have very natural approach vs a full on medical approach. Every profession has great ones and meh ones. Maybe consider that and maybe before you write something so slandering on a profession do a little research.
I've met some wonderful CPMs and CNMs and I've also met some awful CPMs and CNMs. I also know some OBGYNs who provide wonderful, personalized care and some who provide almost no care at all. It's not necessarily the certification; I think it is more the way a provider chooses to practice. I personally employee a CNM who scheduled an hour for my initial appointment during which we discuss my entire life, including nutrition, psychological health, and everything in between, and then 30 minutes for each appointment thereafter, the entirety of which is spent with her. I think it's really important to interview every provider before you hire regardless of the ABCs after their name.
Great point. Thanks for sharing!
As I get you were unhappy with one CNM in comparison to your CPM, this clumps that person to a whole profession. I know so many midwives who have long visits, develop a relationship, help with nutrition and exercise, etc. And I'm sure there's some CPMs who don't. The real trick is finding the best care provider for you. I hope others who read this realize that as well.
You're totally right!
I think what you are actually describing is practice setting differences, not credential differences. If you compare an OOH practitioner that may only have 5 patients Total compared to a CNM in a busy office practice with 20-30 patients per day to see, you will obviously see a huge variance in time and attention. This is why choice of practice setting matters, as a practitioner can only do so much within the setting they are given...
I had a completely opposite experience. I didn't feel taken care of by my CPM at all. Despite spending far less time with the CNMs I felt like they were much more knowledgeable and on top of testing and asking important questions. I'm glad I switched.