The Midwives: Interview the Midwives

Here are the answers to some of the questions that we are routinely asked during our Interview appointments:

What is the difference between a CNM, CPM, a Licensed Midwife, and a lay midwife?
How far overdue can I go?
Do you cut episiotomies?
What is your policy on VBAC (vaginal birth after Cesarean)?
What about waterbirth?
Do you do intermittent monitoring?
Can I have a saline lock instead of a regular IV?
What are the options for pain management in labor?

What is the difference between a Certified Nurse Midwife, a Certified Professional Midwife, a Licensed Midwife, and a lay midwife?
[Note: this answer borrows liberally from the Wikipedia definitions and has been edited for further clarification and accuracy]

A Certified Nurse Midwife (such as each of the CNMs at Lone Star Nurse Midwives) is educated in both nursing and midwifery and provides gynecological and midwifery care of relatively healthy women. In addition to licensing, many nurse-midwives have (and every Lone Star midwife has) a Master's Degree in nursing, public health, or midwifery. Nurse-midwives practice in hospitals, medical clinics and private offices and may deliver babies in hospitals, birth centers and at home. They are able to prescribe medications in all 50 states. Nurse-midwives provide care to women from puberty through menopause. Nurse-midwives often (as here at Lone Star) work closely with obstetricians, who provide consultation and assistance to patients who develop complications. Often, women with high risk pregnancies can receive the benefits of midwifery care from a nurse-midwife in collaboration with a physician. The American College of Nurse-Midwives (www.acnm.org) accredits nurse-midwifery/midwifery education programs and serves as the national professional society for the nation's certified nurse-midwives and certified midwives. In Texas, CNMs are licensed and regulated by the Texas Board of Nursing (www.bne.state.tx.us).

A Certified Professional Midwife (CPM) is an independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwives model of care primarily in the home setting. At present, there are approximately 900 CPMs practicing in the US. The certification process does not require formal academic preparation but encompasses multiple routes of entry including apprenticeship, self-study, and private midwifery programs.

A Licensed Midwife is a midwife who is licensed to practice in a particular state. Currently, licensure for direct-entry midwives is available in 24 states, including Texas; licenses are issued by the Texas Department of State Health Services.

The term "Lay Midwife" has been used to designate an uncertified or unlicensed midwife who was educated through informal routes such as self-study or apprenticeship rather than through a formal program. This term does not necessarily mean a low level of education, but rather that the midwife either chose not to become certified or licensed or there was no certification available for her type of education (as was the fact before the Certified Professional Midwife (CPM) credential was available).

How far overdue can I go?

We recommend delivery before 42 weeks- usually around 41 ½ weeks. After 41 weeks we recommend more frequent prenatal care, including Non-Stress tests and ultrasounds to check on the baby’s placenta and amniotic fluid levels. We are skilled in advising women on natural ways to ‘encourage’ labor to begin before 41 weeks!

Do you cut episiotomies?

As a practice, the Lone Star midwives do not cut routine episiotomies. We understand that women often have better healing if they tear naturally, although we try to prevent tearing altogether! We will encourage you to deliver your baby’s head slowly, and we often use mineral oil and massageto help your tissue stretch.

What is your policy on VBAC (vaginal birth after Cesarean)?

We accept women for VBAC who have had one prior Cesarean section. The c-section must have been a “Low-Transverse” incision in the uterus- we can usually get this information from your old surgical report. We will not offer any type of induction for a woman attempting a VBAC, and labor must occur before 41 weeks. If the pregnancy proceeds past 41 weeks, a repeat C-Section is our recommendation. A woman who is having a VBAC must be continually monitored during labor, but internal fetal monitors are not required.

What about waterbirth?

We do not offer waterbirth at this time. The labor rooms at St. Lukes Baptist Hospital have wonderful showers, and we encourage women to labor in the shower to ease the discomforts of labor.

Do you do intermittent monitoring?

For women who desire natural (without pain medication) childbirth, we use intermittent fetal monitoring so that the woman can change positions, walk, shower, and move freely. If the laboring woman has an epidural, is on Pitocin, or is a VBAC, continuous monitoring will be used. If your labor necessitates continuous fetal monitoring, you do not have to be confined to bed- you can change positions, use the birthing ball, rocking chair, and standing positions.

Can I have a saline lock instead of a regular IV?

Depending on the progression of your labor, you do not need to have continuous IV fluids, so a saline lock can be used instead. We do not recommend laboring without IV access.

What are the options for pain management in labor?

In our practice, women choose epidurals, IV pain medication (Nubain), and unmedicated births. We are supportive of whatever you choose, even if your plan changes during your labor! The epidural typically provides complete relief from the pain of contractions but will limit your mobility as you labor. IV pain medication will provide some pain relief but will wear off as labor progresses. We will discuss these options in more detail throughout your pregnancy as you prepare for your birth!