If you read my last blog, now you understand what separates a midwife from an OB. But the conversation doesn't end there. You won't always get the exact same kind of care from midwife to midwife. Not all midwives do hospital births, not all midwives do homebirths. Only CNMs (in California) can work in a hospital to deliver babies. Both can have a homebirth or birth center practice... Certified Nurse Midwives become RNs before adding on about another couple years of education to earn their Midwife-status. Their education is usually within a typical college. As they become nurses first, they often hear about birth as described in the modern-medicine way. If they only ever work in a hospital, they might earn the slang natural-birthing community label "med-wife," if they practice no different than an OBGYN. However, many CNMs maintain the midwife philosophy that birth is generally safe and natural left alone and respected physiologically. Sometimes, they become frustrated if they work in a hospital and find themselves creating their own homebirth practice or birth center. But, because of their RN background, they are generally more acceptable for insurance companies. In the Temecula area, there is no known CNM who routinely attends homebirths. However, there are a few San Diego based CNMs who have been known to make exceptions now and then. Most Kaiser hospitals in southern CA use CNMs for the majority of their deliveries. CNMs can accept Tri Care Standard, this is why they are used at the military bases for most deliveries as well. There is a birth center in driving distance called Tree of Life and the CNMs there can take a variation of insurances including Tri Care, there is no co-pay for Tri Care standard moms. And they also have an agreement for hospital transfers with Encinitas where they can continue as the main care provider even after the transfer (as long as the birth is vaginal). CNMs are also used at the UCSD birth center in San Diego. This birth center is within a hospital, but the birth center is a separate floor and maintains a true birth center feel to it. The midwives there are incredibly impressive in the way that they maintain respectful, expectant management, evidence-based care. UCSD accepts many insurances including Medi-Cal. Not only does UCSD and the military hospitals all use CNMs, but they all also offer Nitrous Oxide as a pain-relief option.
A Certified Professional Midwife, or a Licensed Midwife are equally equipped for birth as much as a CNM. They are both trained, educated, and highly experienced medical professionals. From my perspective, they might even be MORE willing to resolve a challenge than rely on a quick-fix in the Operating Room. For example, they wouldn't so quickly look at a birth with a baby who's head was positioned difficultly for dissention and resolve to surgically remove the baby without trying to physically manipulate baby's position. In other words, home birth midwives in particular must be of the MOST skilled to handle challenges because they actually CANNOT rely on an OR at all. In the case of a true emergency, they will suggest a transfer to a hospital where an OBGYN will take over. Some CPMs/LMs go to a school just for midwifery. The Nizhoni Institute of Midwifery is one of those schools and it's in San Diego. Others might do a different program but they all eventually take the NARM (national association of registered midwives) test which is regulated by the same medical board that regulates OBGYNs. LMs must also spend hundreds of hours working with an existing midwife as a predecessor. Sometimes they act in the role of the assistant as they learn. Sometimes the existing midwife works with another midwife as her assistant instead. From my experience in Southern California, most homebirth midwives work closely with other midwives and usually never attend a birth by themselves. Although they are educated in Breech and Twin deliveries, they are legally restricted from delivering those babies. They also have legal restrictions in California to not provide care for a woman birthing earlier than 37 weeks or later than 42 weeks. Thankfully, they can still provide care for VBACs (vaginal births after cesarean). Hopefully there will be more freedoms for them as this political battle moves forward. On a better note, LMs now have the potential to accept Medi Cal! In this area, we have a wonderful midwife who accepts Medi Cal and her name is Cristi Lewis. She and another awesome midwife, Karen Pecora, are working on opening a birth center in Fallbrook called Acorn Midwifery. Keep in touch with Cristi (who also works as a Homeopath): http://highroadhomeopathy.com/About_Cristi_Lewis/index.html There are different high risk variables that some midwives can still provide care for, there are some high risk variables that midwives would try and resolve naturally (for example, naturally lower blood pressure so a woman can get off medication), and there are other high risk complications that are best suited in the hands of an OBGYN in the hospital. Sometimes, parents chose to do co-care. This means they have both an OBGYN and a Homebirth Midwife. They know that the doctor is there if they need him/her but listen carefully to their midwives and do everything they can to not need them.
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Karen Brann
Birth Doula, Childbirth Educator, Lactation Educator/Counselor Archives
July 2019
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