# CNM vs. LM



## naturegirl7 (Jan 27, 2005)

Aside from the obvious (one being a nurse and one not) what is the difference between a Certified Nurse Midwife and a Licensed Midwife?
Is the scope of practice different?
What kind of and how much schooling does a LM get?
Do LM only do homebirths?
Can LM take on "higher risk patients" like ones with GD, pre-eclampsia, or history of "difficult" deliveries? Most CNMs I know could.
Do they use backup OBs like CNMs?

What is your personal experience with either?

Here is my experience and why I am asking;
With DS I had a CNM in a hospital - cuz that was all that was available. It was a great experience for the most part (everything except being in the hospital). It was in a birth center styled room with tub, queensized bed, dim lighting, music, etc. I had the most amazing MW in the world, I switched to her at 28wks pregnant and it was the best decision I ever made. She is indepently practicing, with a backup OB rather than within an OB's practice and I found that made a huge difference in her approach to my care. She is very proactive with prenatal care and very "hands off" in her approach - encouraged me to stay out of the hospial as long as possible, go eat, go walk, doesnt do routine IVs, offers waterbirths, etc (she used to have a birth center in teh area until the hospital refused to renew the lease). She stayed with me thru the entire labor, coaching me, giving me gingerale and cran juice, and making me feel like I could do it. My 9lb9z beautiful rolly polly DS got seriously stuck, position changes weren't doing it, she reached in to unhook his shoulder off my pubic bone (his shoulders were actually bigger than his head!!) and finally he came out in the hands and knees position (a tiny bit blue). She defended us to the cranky old nursery nurse - to make sure he came right to me and breastfeed. I had the best MW in the world, and now I am at a loss as to how to find someone just as good as her.

Now we have moved, and Florida does it differently. All the CNMs seem to practice in the hospitals - and I have heard horrible things about the hospitals and natural births down here. There is a CNM who does homebirth a little over an hour away, and birth center a little over an hour away if we manage to catch 95 without traffic, or tons of LM who do homebirths close by.
I know I don't want a hospital birth again. Birth center would be great. Home would be great, but I am a bit nervous that the next one might get stuck again. DS had minor Erbs palsy as a result of getting stuck (and the stupid delivery nurse pushing on my stomach while the MW was yelling at her to stop), and honestly I credit the MW (and our chiropractor) with the fact that he has use of his arm - an OB or a more medical CNM would have let the nurse push on my stomach to "help" the baby come out - stretching his arm and neck even further and possibly causing permanent nerve damage. I am terrified of that happening again without my MW there to make it all okay. Or that they will recommend induction (or worse) cuz the next one is "too big" - especially since I now have a "history of big babies."

I figure if I start searching and researching now, maybe I will have someone I like when I am ready to get pregnant in 6 months or so. It will hinge of finding a great MW. DH laughs, but I will not make a baby until I find someone I trust enough to catch that baby. And they have pretty big shoes to fill.


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## jengacnm (Oct 26, 2006)

I'd recommend interviewing a few of the local LM's and sharing your experience with them, and possibly interviewing the 1 hr away CNM and the 1 hr away birthing center.

An LM with 10-15 years of experience may inspire your confidence more than a new homebirth CNM.

Be sure to ask what kind of resuscitation equipment they bring. Oxygen is needed for a severe shoulder dystocia; otherwise, the steps of how to handle one aren't tied to education preparation. Other than traditional medical folks not using position changes.

Good luck!
Jennifer


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## Baby Hopes (Jul 15, 2004)

Our experience has been that each individual midwife is unique in her own ways. Some LM were even MORE medically minded them some of the homebirth CNM's we interviewed. I realize that this is not usually the case, it's just an example of the variety available within the same fields. In our situation we ended up choosing a homebirth CNM and LOVED the work she did for us.

However, by the same token there are some really amazing LM in this area who have incredible experience with high risk births that most other midwives wouldn't touch. So really, I would suggest like a PP that you just start interviewing midwives.


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## ckhagen (Sep 6, 2004)

Well, in Florida (I am in FL), I personally won't ever use a CNM. I would just go straight to an OB. They're so strongarmed by the OBs they work for that virtually everything ends up being like OB care in the end.

In this part of Florida we don't have any CNMs who do deliveries outside of the hospital. That has much to do with the state regs that say a CNM must work in conjunction with an OB. There are no OBs up here who will back a CNM doing a hb because the liability is traced right back to the OB. LMs almost always have a backup OB, but aren't relegated to running every decision by the OB first, kwim? Many of my friends up here have gone to the CNMs thinking they were going to be under the midwifery model of care, only to find out along the way that they were just seeing an OB in midwives clothing. They were still being treated like cattle in the offices, being threatened with dead baby cards for refusing testing, and having induction pushed starting around 38 weeks.

LMs in Florida can only take low-risk mothers (and VBACs if they have an OB backup willing to do the consent meeting/sign-off) and can only do homebirths.

I'm sorry about the shoulder distocia with your first







It always worries me considering I have huge babies. But, it't unlikely to repeat and honestly, in my situation I trusted my LM/CPM to be able to handle it much more appropriately than I would have ever trusted my OB. I don't think she would have had a clue what to do because she told me after he was born (by c-section) that she would have most certainly had to break his collarbone to get him out.

Definitely go interview your options. I know it's very confusing from state to state as to licensing and how it's handled.


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## Peony (Nov 27, 2003)

Quote:


Originally Posted by *Baby Hopes* 
Our experience has been that each individual midwife is unique in her own ways. Some LM were even MORE medically minded them some of the homebirth CNM's we interviewed. I realize that this is not usually the case, it's just an example of the variety available within the same fields. In our situation we ended up choosing a homebirth CNM and LOVED the work she did for us.

However, by the same token there are some really amazing LM in this area who have incredible experience with high risk births that most other midwives wouldn't touch. So really, I would suggest like a PP that you just start interviewing midwives.









I started off with a LM when I was pg with DD2, and she was so medically minded that I couldn't stand it. Vag checks, pitched a fit when I refused the glucose test, etc... I ran away from her very quickly and ended up with a CNM who couldn't be more hands off. In my state LM's are very limited to what patients they can take, CNM's can legally do breech, twins, VBAC's, all the things LM can't do.

I'd interview and get a feel for what each MW is like, what they will do, sometimes there are gray areas within a state's laws and some LM's will work within that area, and others wouldn't touch it with a 10 ft pole, IYKWIM.


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## turtlewomyn (Jun 5, 2005)

I am also in Florida, and I think I may know the CNM that you are talking about. I used to live in the WPB area. I did meet a CNM that was practicing in the Treasure Coast that did homebirths.
I was burned by a CNM in a hospital (she worked for an OB/GYN group and told me over the phone that I should have a c-section for a "big baby"). If a CNM works for an OB/GYN group she may be bound by all their regulations/group policies that may "require" medical interventions in certain situations. A CNM that does home births on her own may not.
I think the important thing would be to interview all of your potential care providers. Since SD and injuries from SD are a concern to you, I would specifically ask them about their experience with SD and how they handle it. The United Brachial Plexus Network has a great brochure about this.


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## loraxc (Aug 14, 2003)

Quote:

LMs in Florida can only take low-risk mothers (and VBACs if they have an OB backup willing to do the consent meeting/sign-off) and can only do homebirths.
Not so, actually. Here in Gainesville, FL we have a freestanding birth center where LMs attend.

I'm also in FL and am currently trying to choose between a birth center staffed by CNMs and one staffed by LMs. OP, I understand you feeling--my first birth was a difficult birth center-hospital transfer attended by a CNM who I felt really went to bat for me. I'm worried about a hospital transfer with LMs, because these don't have hospital privileges. At the same time, I felt my CNM care was overly medicalized.


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## naturegirl7 (Jan 27, 2005)

thank you for all the replies.
I wish I could just have my MW from up north hop and plane and deliver the next baby for me too. But that is not realistic.

Thanks for the tip on that brochure too - i will definitely look into it and bring it with me when I interview. Honestly that is my biggest fear, that the next one will be even bigger(my nieces all weighed in between 8 - 11lbs at birth and DS was 9.9), and that he/she will also get stuck and this new MW will not be able to handle it the way my other MW did. Or that I could end up getting backed into a hospital birth or worse.

I am terrified of my next child being hurt - perhaps permanently. It was so scary sitting in the hospital trying to drag answers out of the endless stream of peds, all the while holding my beautiful baby boy whose head flopped at an unnatural angle and whose one arm was completely limp....or the heartbreaking struggle it was to nurse him since his head was angled so weird and he was in such pain....

I think I will email my MW from back home and see if there is anything she recommends asking too.


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## ckhagen (Sep 6, 2004)

Quote:


Originally Posted by *loraxc* 
Not so, actually. Here in Gainesville, FL we have a freestanding birth center where LMs attend.

Yeah, I meant to say "out-of-hospital" rather than HB. They just can't get hospital privledges.


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## Belleweather (Nov 11, 2004)

We were thinking about moving to colorado because dh got a job offer there, and they have much the same situation (although I have heard decent things about their hospitals... I'm just too big a believer that "if you buy the hospital ticket, you go on the hospital ride" to even look into that.) But in Colorado, LMs doing homebirth can't write prescriptions and most don't do follow up well-woman care. I don't know what the situation is in Flordia, but if you need an Rx during your pregnancy (zofran, antacids, whatever) you might want to check that out.


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