What’s the Difference between a CNM and an OB?

Many people think of a midwife as the classic home birth midwife. However, there are actually three different types of midwives: a certified midwife (CM), a certified professional midwife (CPM), and a certified nurse midwife (CNM). I am a licensed CNM, which means I have a master’s degree from an approved university (in my case the University of Utah), and then I passed a national test offered by the American Midwifery Certification Board.

Midwives view birth as a normal part of a woman’s life, instead of a condition that needs to be treated. Midwives promote normal childbirth and the prevention of health problems. Women under the care of midwives are typically less likely to have a cesarean delivery, an episiotomy, and other interventions.

Midwives also spend more time with women during pregnancy appointments and at the bedside during labor, birth, and postpartum. At prenatal appointments, midwives try to look not just at the patient’s chart, but see her as an individual person with specific wants, needs, and resources. Instead of telling patients what to do, midwives try to educate and then let women make informed choices about pregnancy to help prepare for childbirth.

Once the big day arrives, a midwife will be there to help the laboring mother through the delivery process. Having a midwife does not mean you cannot have an epidural. However, if a woman chooses not to have an epidural, midwives provide beside labor support to help the mother achieve this goal. If a labor goes slower than expected, instead of jumping to pitocin or forceps, midwives first use position change, ambulation, or other less aggressive techniques.

During childbirth, midwives are more comfortable with alternative birthing positions. It is often more effective, and more comfortable for a woman to push while squatting, lying on her side, or in the hands and knees position. Such positions often help babies be in better location in the pelvis, which leads to easier pushing and less tearing. Midwives support waiting to cut the umbilical cord. By simply waiting to cut the umbilical cord, babies have better iron stores and are less anemic. Also at birth, midwives prefer to place the baby directly on the mother’s abdomen so they can be skin to skin and not separated. This interaction is part of the Baby Friendly Initiatives that Lakeview Hospital is adopting – one of the reasons I love to deliver at Lakeview Hospital. After delivery, midwives spend extra time helping women with breastfeeding and recovery.

Midwives use the same evidence as obstetricians, and can still recognize when intervention is necessary. Both midwives and obstetricians want the same goal of a healthy outcome. Midwives are not licensed to perform cesarean sections or forceps, which is why they have obstetric coverage if complications arise. Many midwives, like myself, can assist during these procedures and are still able to help care for the woman afterwards.

Midwives don’t just see women for pregnancy. They also see women for a variety of healthcare needs throughout a woman’s lifetime. Most CNMs work in a women’s health clinic where they see patients for pregnancy care, menopause, birth control, physicals, emotional health, as well as other acute and chronic conditions.

-Laura Zaugg, Certified Nurse Midwife

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