All About CPMs

What is a Certified Professional Midwife?

CPMs are midwives who have completed the requirements for credentialing by the North American Registry of Midwives (NARM).

“A Certified Professional Midwife’s (CPM) competency is established through training, education, and supervised clinical experience, followed by successful completion of a written examination. The goal is to increase public safety by setting standards for midwives who practice ‘The Midwives Model of Care’ predominately in out-of-hospital settings.” – NARM.org

CPMs in South Dakota have additional requirements, being that they have completed a didactic course accredited by MEAC (Midwifery Education Accreditation Council), which is a two- or four-year degree (depending on institution).

CPMs spend on average 4-6 years in apprenticeship, learning hands-on skills and clinical decision making under an experienced midwife. They are also required to be proficient in Neonatal Resuscitation and other emergency procedures, and must renew their credentials every three years, completing at least 25 hours of continuing education during that renewal cycle.

What is The Midwives Model of Care™?

The Midwives Model of Care is best explained by the Midwives Alliance of North America (MANA):

“The Midwives Model of Care™ is a fundamentally different approach to pregnancy and childbirth than contemporary obstetrics. Midwifery care is uniquely nurturing, hands-on care before, during, and after birth. Midwives are health care professionals specializing in pregnancy and childbirth who develop a trusting relationship with their clients, which results in confident, supported labor and birth. While there are different types of midwives practicing in various settings, all midwives are trained to provide comprehensive prenatal care and education, guide labor and birth, address complications, and care for newborns. The Midwives Model of Care™ is based on the fact that pregnancy and birth are normal life events. The Midwives Model of Care includes:

monitoring the physical, psychological and social well-being of the mother/birthing parent throughout the childbearing cycle
providing the mother/birthing parent with individualized education, counseling, and prenatal care, continuous hands-on assistance during labor and delivery, and postpartum support
minimizing technological interventions and
identifying and referring women/birthing people who require obstetrical attention.

The application of this model has been proven to reduce to incidence of birth injury, trauma, and cesarean section.

[mana.org/about-midwives/midwifery-model]

Where can I birth with a CPM?

CPMs work exclusively out-of-hospital, though we always endeavor to maintain a positive working relationship with local hospitals in order to ensure smooth transitions in the event of a necessary transfer. This exclusivity means we are experts in birth outside of a hospital and have all kinds of creative tricks up our sleeves to help support families, and keep them safe, as they birth in the comfort of their homes.

What if there’s an emergency?

Although we do frequent screenings and gentle interventions throughout pregnancy to make sure you remain low-risk, birth can surprise us with complications at the last minute. If this happens, we are trained to handle every emergency and have a plan for each situation. Some emergencies can be handled out-of-hospital, while others will require an emergency transport. We know where that line is, and we utilize Emergency Medical Services as necessary. In South Dakota, our license enables us to carry oxygen, IV fluids, anti-hemorrhagic medications, and various resuscitation devices to either resolve the issue or stabilize for transport. We bring this emergency equipment to every birth.

What does prenatal care look like? How is it different than an OB?

Many of the tests and procedures we do are similar to what OBs provide. We can draw blood and evaluate labs, take urine samples and cultures, test for infection, provide internal exams, and order ultrasounds. Other aspects of care will be very different. We spend about an hour on average with you at each appointment. That’s not you sitting in an exam room and waiting—that’s one-on-one face time with your midwife.

At each visit, we will take your vital signs (blood pressure, pulse, urine dipstick, etc.) and check in on baby with either a fetoscope or a doppler (your choice!). We will also palpate your belly to see where baby is, determine their position, and measure your fundus (the top of your uterus). We will talk about common pregnancy discomforts, offer non-pharmaceutical suggestions for those discomforts, and screen for any complications. We will have discussions about what decisions you want to make in pregnancy and for labor and birth, always in a no-pressure, informed-consent manner. We will talk about your life at home, your feelings about your pregnancy and upcoming birth, your plans for the birth, and parenting choices. We will listen to your hopes and fears, and offer you guidance and encouragement along the way.

How does home birth look different than in the hospital?

We will come to you during labor, so you will not need to go anywhere. You will keep in contact with us during early labor (via text or phone), and we will decide together when the midwifery team should come. We know that birth works best when it’s undisturbed, so unless something comes up that needs help (for example, baby in a funny position), we will spend most of our time observing and waiting for the birth. We do intermittent monitoring of your vitals and baby’s heartrate. You can move as you like and be wherever you want. We’ll encourage you to eat throughout labor and will not force you to be in any particular position during pushing (except if medically necessary, which is very rare). You can give birth on your couch, on your bed, in a birth tub, in your shower, on your living room floor—anywhere in your home! We love seeing partners catch the baby and will coach them through it, or if you want your partner holding you instead, we can do the catching.

After your baby is born, they will go right to you, to lay on your chest while you meet them. We will leave the umbilical cord intact until the placenta is delivered. We’ll check baby’s breathing and heartbeat, and we may help them to breathe with a few puffs of air or by clearing their mouth and nasal passageways. After things have settled down, we’ll do a newborn exam and take all of baby’s measurements, check for congenital anatomical differences, and assess neurological development. At this time we can also administer vitamin K in either an intramuscular injection or orally, and we can provide erythromycin eye ointment (these are NOT required and only offered—always the parents’ choice!). If there is a tear, we can either glue it or suture it (depending on depth and your preference). We’ll help you to get the first latch, answer any questions you may have, and provide you with information so you can feel confident when we leave you to rest. We remain available to you at any time with questions or concerns.

What kind of care is given postpartum

We will come to your home for your first two postpartum visits. These occur typically at 24-36 hours and at 3-4 days postpartum. At the 24-36 hour visit, we will check on both you and the baby to see how you’re both recovering from the birth. If desired, we can also perform the PKU (heel poke) test to screen for metabolic disorders in baby. We will also check for jaundice in baby at both visits. We will offer advice and guidance on the newborn period and will make suggestions as needed. Beyond the first two home visits, we will provide up to six weeks of care for you and baby, including lactation counseling and screening for Postpartum Mood Disorders (PPMDs). We do not provide vaccinations or perform circumcisions. At six weeks postpartum, we will offer to check your stitches (if you had any) and give you the “all clear” for your usual activities. We can also perform a pap smear at this time if you are due for one, and we can discuss birth control options.

Can CPMs write prescriptions?

Although we can carry certain medications, including antibiotics for use during labor, our license is limited to only birth-related legend drugs. However, we can partner with your primary care provider, an OB, or a CNM, to provide you with necessary medications. Sometimes there are acute (short-term) conditions, such as a UTI, which can be treated with antibiotics but does not require you to be in full OB care, and so we can do “co-care” by continuing to work with you even while another provider prescribes for that particular condition.

Will my religious or cultural practices be respected?

Yes! Unless the practice would cause direct harm or neglect to yourself or your child, we will respect your personal beliefs and will be happy to either participate (as you desire) or to observe quietly.

How much does home birth cost? Do you take insurance?

Costs will vary by location and by midwife. In most cases, home birth averages around $4,000 to $6,000. Compare to hospital costs, even with insurance, which can be upwards of $8,000 for even the simplest of births. Also keep in mind that this price is for almost a year of care (ten to eleven months depending on when care began) with a midwife on-call 24/7. In addition to providing your midwife with a living wage, this also pays for all supplies, her equipment and its maintenance, administrative costs, electronic health records, travel (gas, vehicle maintenance), herbs and medications used in labor, the assistant’s wages, and your midwife’s credential, licensing, and continuing education fees.

Insurance coverage of CPMs can be hit-or-miss, so it's important to always check with your insurance company to find out their policies. CPMs are not currently in-network providers, but some companies may be willing to pay CPMs as out-of-network providers, reimburse you after paying me, or may count your expenses towards your deductible.

I always offer payment plans and can accept Health Savings Account payments. Healthshare groups are often willing to cover midwifery care, but the details and assurance of coverage will need to be confirmed by your chosen company.

What other services should I consider?

We strongly encourage first-time parents to hire a doula, to help guide them and add to their overall support. You may also want a postpartum doula, who can help you through the early stages of recovery and newborn parenting. Many parents also choose to hire a photographer, who can provide you with wonderful memories. Other suggestions to add to your care include chiropractic, massage, acupuncture, and other bodywork. These can not only relieve discomfort in pregnancy, but may also make labor easier and quicker by “clearing the path” for your baby. If you are already seeing a bodyworker regularly, be sure to tell them you are pregnant, as some methods or points may be inappropriate during pregnancy.

What’s the difference between a midwife and a doula?

A midwife is a trained medical provider who manages a family’s pregnancy, labor, and birth, and is capable of providing testing, monitoring, and clinical assessment, as well as emergency medical attention during birth. A doula provides education, resources, and advice during the childbearing year, but does NOT provide any clinical care. Doulas and midwives can work very well together, as they have different, but complementary, roles. The doula will be primarily focused on the family’s emotional and physical comfort, while the midwife will be more focused on safety and clinical aspects of care. Midwives do often incorporate doula techniques in their labor support, and they can take on the role of doula in the event of a transfer to the hospital, but their first responsibility is to the health and safety of their clients, while the doula’s first responsibility is to the comfort and education of their client.

Can I have a midwife if…?

Many parents wonder whether they are appropriate for out-of-hospital birth with a CPM. Most people will be able to birth outside the hospital, since most births are low-risk without complications. Whether you, individually, can have a CPM will be determined by the CPM and her state’s licensing rules. The best way to know whether CPM care is right for you is to set up a consultation with her and discuss your health history, risk factors, and goals for birth. Click here for South Dakota CPM License Rules.