Although there are certainly many articles on the internet explaining the practice of midwifery and different types of midwives, I wanted to contribute my own experience on the subject.
The two types of midwives available in my area, in California, are direct entry midwives and certified nurse midwives, or CNMs. When I was pregnant, I started out with a CNM at a birth center, but later switched to a direct entry midwife. Here’s what I learned through the process.
CNMs are certified as nurses, as their title may suggest. They are commonly found in hospitals and birthing centers. Direct entry midwives have birth training adequate to be certified by a governing board such as the North American Registry of Midwives or the American Midwifery Certification Board, and may have the title of CPM (certified professional midwife) or CM (certified midwife)—these types of midwives most commonly attend home-births or births in a birthing center.
Certified Nurse Midwives
Originally, I chose to use a birthing center which employed several certified nurse midwives. I found the birthing center to be a very appealing environment, and I felt more secure using a midwife who was also a certified nurse. Birthing at the birth center seemed like a safer way to have a natural birth.
I quickly found that I was not assigned to one particular midwife, but would get whoever happened to be there during my appointment. This may be unique to the particular birthing center I chose, but I did feel that my care was less personalized as a result—undermining one of the main benefits of midwifery as opposed to seeing an OBGYN. Ironically, most people seeing an OBGYN would at least have the benefit of receiving care from a single doctor, rather than a rotating set of doctors, thus giving them more personalized care than I was receiving at that birth center.
I also discovered that my care was very managed at the birth center. There were protocols, procedures, and rules that I was simply told to follow, without a great deal of input of my own preferences or thoughts. This is apparently the usual operating procedure for CNMs. I was told to submit to a pelvic exam during one appointment—not asked, but told. Another time, I was told to submit to a blood draw for blood tests. Neither of those procedures was offered to me for consideration, they were just an expected part of the process, and I was not given an option to decline. I found that this undermined another of the main benefits of midwifery, which is the right to be involved and in control of one’s own prenatal care.
The final straw for me with the CNMs at the birth center was when I was told to make my appointment for the gestational diabetes test. After carefully researching the subject, I found that I have an extremely low risk of gestational diabetes. I had not a single risk factor, other than being pregnant. As such, I spoke to one of the midwives about declining this test, and she agreed that it would be fine. Later, I received a call from the birth center again requesting for me to make my appointment, and when I explained that I would be declining, they put me on hold. A few minutes later, they came back and told me that it wasn’t allowed. I was flabbergasted to hear that I apparently wasn’t allowed to make my own health care choices, but I remained calm as I explained that I already received approval from one of the midwives. I was told that they would get back to me on the matter. A few days later, I received another call from the birth center. They told me that they had discussed my case in their staff meeting, and decided that I would not be allowed to decline the test. I told them I would be finding a new midwife.
At this point, I started to really look into all of the available midwives in my area, rather than only looking for CNMs, which there were only a couple of. That was when I finally came around to the idea of seeing a direct entry midwife, and discovered many benefits to this choice.
Direct Entry Midwives
First of all, with a direct entry midwife I was able to have a home birth without paying any extra fee as I would have had to for the birth center I was at before. I discovered that midwives bring all of the same equipment to a home birth as would be available at a birth center, making it just as safe of a choice. Not only that, but a home birth allows the family to be in a familiar and comfortable environment, and eliminates the need to do anything after the birth other than settle in with the new baby. That being said, direct entry midwives often work at birthing centers as well (my midwife has her own birthing center), and offer that as an option.
Second of all, I was able to choose the one person who would take care of my prenatal needs, and build a relationship of trust and comfortability with that person. There was no shuffling around with a different midwife every month.
Third, I was able to make my own health choices and wasn’t pressured to submit to any procedure. Everything was my choice, and everything was presented as an option, as it should be. I chose to decline certain procedures, such as the gestational diabetes screening, while accepting other procedures such as screening for GBS (Group B Strep). None of my choices felt judged by my midwife. I also was never even offered a pelvic exam until the birthing time, which is good because pelvic exams during pregnancy are not evidence-based or beneficial, and may in fact be harmful (not to mention uncomfortable).
Ultimately, I was very happy with my choice and I highly recommend direct entry midwives as an option for pregnancy and birth care. Not only did I have a much better experience, but I paid less for it, and it was much more convenient to have a midwife who was located closer to me and able to attend my home birth. My midwife happens to see clients at her birth center, but also offers a home-visit option, and many direct entry midwives offer home-visits only. Either way, using a CM or CPM is a wonderful way to receive excellent, personalized, and empowering care during pregnancy and birth. As for CNM care, I can only say that my experience was very negative, but others may find that this type of midwife suits them. Ultimately, the decision should be made with an open, yet discerning, mind.