CNM vs. CPM

Many people may wonder WHY on EARTH I would choose to be a Certified Professional Midwife rather than a Certified Nurse-Midwife. After all, the benefits of being a CNM are great. You get a starting out salary of $90,000, it's easy to find work, you can write prescriptions and do hospital deliveries. So I'm going to discuss my decision with you.

In the last few months I have done a lot of networking on facebook with other people in the natural birth (global) community. One of the Midwives I have friended is Gloria Lemay. Most of you will not know who she is, but in the midwifery community she is quite acclaimed. She has probably the best midwifery blog out there and often writes for Midwifery Today magazine. It is from her that I get a lot of the articles that I re-post to my Butterfly Births page. In my autodidactical midwifery education I have read and seen many things, several of which were from Gloria, that convinced me that I did not want to be a CNM.

First of all, CNMs are not autonomous midwives. They can only be Registered in their state if they have a collaborating physician. It is possible, as in Donna's case, to fine a physician that will let you work autonomously while they sign the necessary papers and do the occasional referrals. But for the most part physicians are unaware that this is a possibility and they are concerned for liability. Most CNMs work as part of a Practice that is run by physicians. They must adhere to the guidelines of the practice. This means that if the Guidelines say that patients must be induced after 41 weeks, then the midwives must follow that standard. If a physician comes into the hospital and says to put the laboring woman on Continuous Fetal Monitoring, the Midwife must do that also. I want to be a Midwife so that women have the choice of a gentle and safe birth. I want to specifically get away from all of the trouble caused by the medical community and their interventions in labor and birth. This would be difficult, if not impossible, as a Certified Nurse-Midwife.

Also, CNM's must follow "Hospital Regulations." These vary from hospital to hospital, but I have encountered some that are truly atrocious in the Labor and Delivery ward. There is an Army hospital in Fayetteville, NC that requires CFM (continuous fetal monitoring). The hospital employs many CNMs but they practice more like physicians than midwives. CFM increases the rate of intervention and c-section drastically, without any improvement in outcome of mother or child. I would not like to be subject to such hospital regulations. Being a Doula in such an environment is hard enough.

Lastly, if you know me you know that I am not one to be subjected to the Man. I am free-thinking and opinionated. I will not forfeit my freedoms and will stand up for the rights of others. I believe that woman have the right to choose where and with whom they give birth. I believe that the modern American obstetrical system if greatly flawed. That is supported by the numbers. We rank lowest among developed nations in maternity care. We have the HIGHEST rate of maternal/newborn fatality in these nations. Croatia is a safer place to give birth that the U.S.!!! And this is due largely to our flawed medical system which is controlled by fear of litigation and drug companies. I could go on about this and other things that influence our horrid maternity care, but I wont. I just do not want to be a part of it! I want to make a difference and improve maternity care. I want my clients (not "patients") to have the best care for THEM, not the most convenient care for ME. I want to follow in the footsteps of The Netherlands; the homebirth capital of the world and one of the safest places to give birth due to their lack of unnecessary medical intervention.

Anyway, I hope you understand the logic and emotion behind my decision a little better. Comments are welcome.