Natural Birth

Home Birth Help

So after our VERY unpleasant experience having DD in the hospital and a lot of back and forth on my part, DH and I have decided we would really like to have this baby at home.  Colorado seems very home birth friendly, which is both a blessing and curse. The number of options out there makes trying to choose a midwife overwhelming.  For example, can't decide whether it's better to have a CPM with more home birth experience or a CNM with less.  I'm afraid of what would happen with the CPM if I needed to be hospitalized.  Any pointers from anyone who's had a home birth?  I'm not afraid of giving birth at home, just afraid of choosing the wrong person to catch the baby!
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Re: Home Birth Help

  • I personally know many CPMs (I'm a midwifery student), and trust them as much as a CNM. We're going with a CNM just because she was who we had for DS, and I didn't know of any CPM's in our area at that time. I wouldn't let the title get in the way--in fact--many times CNM's tend to be more restricted bc their back up physician has the ultimate say in their policies, etc. In my experience, CPM's tend to be more holistic and more hands-off (less medical). If you needed to be hospitalized, I've heard of CPM's coming along and playing "doula," providing your chart and report.

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  • I'm doing a home birth with CPM. Unlike Colorado, Minnesota is not very home birth friendly, so there weren't a ton of options. I love my midwife, though, and I have nothing but the utmost confidence in her. I know if were to go into labor early, or if for some reason I had to birth in the hospital, she would be by my side the whole way, acting as my support or doula.
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  • image secondaryPULSE:

    I personally know many CPMs (I'm a midwifery student), and trust them as much as a CNM. We're going with a CNM just because she was who we had for DS, and I didn't know of any CPM's in our area at that time. I wouldn't let the title get in the way--in fact--many times CNM's tend to be more restricted bc their back up physician has the ultimate say in their policies, etc. In my experience, CPM's tend to be more holistic and more hands-off (less medical). If you needed to be hospitalized, I've heard of CPM's coming along and playing "doula," providing your chart and report.

    I agree.  We used a CNM for #1, and we gave birth in the hospital.  While it was a great experience, we realized that there was no need for us to be there.  I didn't have an IV, or a tylenol.  We were there for right around 24 hours total (DS came within an hour of arrival) and we had to drive for an hour to get there.  We are using a CPM at home for this baby.  Because of our location, our CPM will be a little more conservative if she feels that a transfer is necessary . . .

    That being said, when you interview your care providers, just talk to them about it.  Ultimately, (IMO) it will boil down to whom you feel most comfortable with and who's standards of care fit best to the type of care you're looking for.   Any midwife CPM or CNM will be able to easily tell you what they look for in a birth, what you can expect from them, and what would happen in the event of a hospital transfer.

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  • Ask the MWs you interview how they decide to transfer to a hospital, where they would like to transfer to, and if they have an OB they work with. It seems like what you are really looking for is a MW (CPM or CNM) who works with a local OB, that way if you do need to transfer to a hospital, there is a plan already worked out. Am I reading your concerns correctly?

    A good CPM should be able to do all the necessary tests during your pregnancy and post-partum care, or at least have someone to send you to if you need the care of someone who went to medical school. Ask about what supplies she has on hand for emergencies during a home birth. A CNM can write prescriptions for emergency drugs, but a CPM needs someone else to write them for you. If you transfer to a hospital, like a PP said, your MW should come with you and act as a doula.

    While a CPM and CNM are different, a good one of either certification should be able to meet all of your needs. I wouldn't pick one just based off the initials after her name. Interview a bunch and find a good fit for you. I had a CPM with an amazing back up OB who saw me in my third trimester and wrote some prescriptions for my home birth. It turned out to be a great choice for us. Good luck!

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  • You're blessed you have so many options!  Our state doesn't allow CPM's to practice legally :-(  However a neighboring state does, and my husband and I seriously considered delivering in the neighboring state w/ a CPM (both our first pregnancy and this pregnancy).  However I decided that I'm just personally not comfortable w/ the CPM's.  It might have been the personality of the ones we had to choose from at the birth center...but in the end we decided we were more comfortable w/ a CNM and will have to deliver in the hospital as a result of that decision.  

     

  • I am not in a very homebirth friendly area.  We don't have ANY CNMs left in the area that practice in the hospitals.  My only choices are between CPMs and DEMs.  With the last birth I chose a team of midwives (CPM and DEM with an apprentice) that had over 40 combined years of experience.  They were extremely qualified and knowledgable.  I am using them again for this birth.

    Honestly, I used a CNM in the hospital for my first two (she since retired) and I would have felt less comfortable with her at home than I did with the CPM and DEM. 

    I think you just need to have a tough interview process.  Ask what they do in the case of a transfer.  As about their stats.  Are they trained to handle breech?  What equipment do they carry?  etc. 

        
  • Where I live, midwives are midwives and all are licensed for home or hospital birth and receive university degrees in midwifery. So take my opinion with a grain of salt, but I personally would not feel comfortable with a CPM. I would go with the CNM for sure.
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  • image Elizabeth0501:
    I'm doing a home birth with CPM. Unlike Colorado, Minnesota is not very home birth friendly, so there weren't a ton of options. I love my midwife, though, and I have nothing but the utmost confidence in her. I know if were to go into labor early, or if for some reason I had to birth in the hospital, she would be by my side the whole way, acting as my support or doula.

     

    This. Illinois isn't Homebirth friendly either. My options were limited and didn't like the CNM in the area. I ended up finding my CPM who was 45 minutes away and totally worth it. 

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  • I had a preemie so couldn't have the home birth I planned but I trusted my CPM 100%.  She has a close relationship with a local OB so going to the hospital was no issue and she was present at the hospital in an unofficial capacity.  I would want someone with a lot of home birth experience for sure.
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  • I have been to birth with, I thought only, CNM that practices in Denver and she was great - so was her assisstant.  They were so smart, relaxed and all around wonderful.  I wasn't the one giving birth, but I did interview her before going to MMC (my DH wasn't keen on home birth at the time, so I had to respect that a little).  If I remember, she has less home birth experience than many, but still has been a CNM since the 80's or 90's, right?  That would count as experience for me.

    I am now using a CPM in a different state, who seems just as great, but I've never seen her in action yet.

    I think if you are comfortable with the midwife and their training, that matters more than which certification.

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  • I almost had a home birth in Colorado (I ended up transferring with my CPM for non emergent reasons and had a successful vbac). I think you have to go with your gut as much as your head in choosing your home birth care provider, and this is coming from someone who is very cerebral. I interviewed several people and had a long list of questions.  I basically thought about every scenario that concerned me and asked them about it. I know birth is unpredictable, but it was more to see what they would say, to get to know them and their philosophies. Part of the reason I wanted a home birth was for the experience, and it was important that someone was technically skilled but also had a deep understanding of us and what we wanted out of this.

     I also listened to input from my doula about different midwives' reputations. There's  also some discussion about local CPMs on the Colorado attachment parenting board (you have to ask to join but it's free). I understand why a CNM is appealing; I would think critically, since you are birthing at home, about who has the most home birth experience. 

     I think it's really important to be on the same page about when you transfer and why. From my understanding, there are no OBs formally backing up home birth midwives in CO (CPMs or the CNM) but there is a hospital that is the preferred transfer hospital that is reasonably happy to accept transfers. Of course, in an emergency, you go to what is closest.

     Hope that helps! Good luck with your decision. 

  • We used a CPM who we trusted 100%. She was very holistic and hands-off.  I couldn't imagine being under the care of anyone else.  Around here they call CNMs "MEDwives" because of their medical type approach to pregnancy, labor and delivery.  That was exact opposite of my belief system.  I know it is different everywhere.  I'd suggest meeting with both CNMs and CPMs and making the decision based on who you are most comfortable with.  GL!
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