That’s kind of what I mean by “the obvious.” I meant why there are differences in their certification, and what the differences are. What do they do differently? What makes one an advantage over the other? Can you compare them like you would compare an ophthalmologist and an optometrist (they both work on eyes, but they can do different things)? Or an MD and a DO (same job, different approach)?

Given the hospital privileges issue, would that mean that CPM is generally associated with home birth and CNM is more associated with an OB/GYN’s office and hospital birth?

Part of why I ask that is that both of the CNMs in that office were homebirth midwives in the past. They had actually worked with a homebirth CPM that I talked to and wanted to use, but my husband felt like we could not afford.

ya. basically. most CNM’s lean more towards hospital type interventions. They -usually- will be the ones who are in favor of rupturing or striping membranes, IV fluids, or not letting you go over 41 weeks.

(Usually in this sense means more prone to then CPM’s, im not speaking in general sense of all CNM’s because CPM’s can lean more towards interventions just as much. im only speaking in comparison of the two)

i’d just like to respectfully argue that nurse-midwives *do* (at least in theory) respect that same principle; that is the midwifery model of care. as a student nurse-midwife, my entire training has focused on seeing the woman as the center of care, giving her informed choice and advocacy, considering the language that is used (so as not to be paternalistic/take power from the mother/etc, but rather leave it with her, where it belongs). we do not deliver — we help catch. this is a point that’s been drilled into us throughout my education. as nurse-midwives – we are there to be with women, the same as CPMs.

that doesn’t mean that sometimes you won’t find an OB-in-midwive’s-clothing; maybe nurse-midwives working in the hospital setting are more likely to have that mindset, because they *are* in the hospital setting and subject to those pressures (the policies, the doc partnerships, insurance, etc, etc) whereas CPM’s are generally not. please, though, don’t take this to mean that *all* CNMs (whether hospital, birth center, or home birth midwives) are solely focused on the medical model of care.

there is no such thing as a ‘perfect’ type of care provider… each type has its pro’s and con’s (some may not be available in all areas, some may not be covered by insurances, some may not be suitable for certain women based on specific risk factors). it shouldn’t matter as ALL women should be given respect, autonomy, and evidence-based care.

and maybe some sparkles and unicorns…

For three births, I had CNMs who didn’t seem *to me* to be medically-minded. I did keep in mind that they were working within a system that expected a certain amount of medicalization, but overall they were very respectful and caring. I would never have called them “medwives” for example.

Jo Ella… i do know what you mean/are asking for and i wish i could give you a good answer. i think it really is kind of a gray area, though — there are differences in training/education, and certification; nurse-midwives obviously have a background in nursing as well as their midwifery training (although i know several CPMs who are also nurses, but chose the CPM route rather than CPM route… i also know some who hold dual CPM and CNM certification). as others have stated, CPMs rarely – if ever (?) – have privileges in the hospital setting, whereas in some states the majority of CNMs practice there. in some areas CPMs and CNMs work beautifully hand-in-hand, and in others there is some contention between the two disciplines (which is really sad to me as there are such unique benefits to both).

anyway, i apologize if my post above was overly defensive… i didn’t mean to come across that way *blush* as CLI82 stated though, many CNMs do have their practice dictated by the policies where they work – if they are in a hospital or birth center setting, working in a collaborative agreement with a physician (which unfortunately is something that many states still require, though it has been shown to be an outdated and really if anything harmful practice). i think for those CNMs who *do* really want to practice FOR women, it leads us to become very frustrated and defensive, because we so want to promote normal, healthy, woman-centered care… and as hard as we fight… ya know??? (but we *do* keep fighting, and we *are* making progress)