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    Frequently Asked Questions

  • What is a Certified Nurse-Midwife?

    A certified nurse-midwife (CNM) is an individual who is educated in both nursing and midwifery and possesses certification through the American Midwifery Certification Midwifery Board (AMCB) according to the requirements of the American College of Nurse-Midwives (ACNM). CNM’s provide primary healthcare to women of all ages including:

    Prenatal care
    Labor and birth care
    Postpartum care
    GYN care
    Newborn care
    Preconception care
    Menopausal management
    Counseling in health maintenance and disease prevention

    A certified nurse-midwife (CNM) is an Advanced Practice Nurse who is licensed to practice in the state of their choice. Most CNM’s start as a Registered Nurse with their Bachelor’s degree and choose to complete their Master’s in Nursing with a specialty in Midwifery. No other midwife can use the term Certified Nurse-Midwife or CNM unless they have completed this education and passed national boards. Essentially, we are a type of Nurse Practitioner with a specialty in pregnancy and women’s health care.

    A CNM in Colorado is regulated by the Department of Regulatory Agencies: Professions and Occupations. The Colorado Nurse Practice Act determines how a CNM in Colorado may practice and the laws, statutes and regulations that go along with that specialty. In Colorado, we are considered INDEPENDENT healthcare practitioners and must follow the standards set by our professional affiliate. This affiliate for CNM’s is the American College of Nurse Midwives (ACNM). Their website may be reached at www.midwife.org. Feel free to peruse their Standard-Setting Documents for more information on CNM’s or you can ask me!

  • What is a Certified Nurse-Midwife?

    A certified nurse-midwife (CNM) is an individual who is educated in both nursing and midwifery and possesses certification through the American Midwifery Certification Midwifery Board (AMCB) according to the requirements of the American College of Nurse-Midwives (ACNM). CNM’s provide primary healthcare to women of all ages including:

    Prenatal care
    Labor and birth care
    Postpartum care
    GYN care
    Newborn care
    Preconception care
    Menopausal management
    Counseling in health maintenance and disease prevention

    A certified nurse-midwife (CNM) is an Advanced Practice Nurse who is licensed to practice in the state of their choice. Most CNM’s start as a Registered Nurse with their Bachelor’s degree and choose to complete their Master’s in Nursing with a specialty in Midwifery. No other midwife can use the term Certified Nurse-Midwife or CNM unless they have completed this education and passed national boards. Essentially, we are a type of Nurse Practitioner with a specialty in pregnancy and women’s health care.

    A CNM in Colorado is regulated by the Department of Regulatory Agencies: Professions and Occupations. The Colorado Nurse Practice Act determines how a CNM in Colorado may practice and the laws, statutes and regulations that go along with that specialty. In Colorado, we are considered INDEPENDENT healthcare practitioners and must follow the standards set by our professional affiliate. This affiliate for CNM’s is the American College of Nurse Midwives (ACNM). Their website may be reached at www.midwife.org. Feel free to peruse their Standard-Setting Documents for more information on CNM’s or you can ask me!

  • Why did you choose to be a certified nurse midwife instead of a certified professional midwife?

    Sometimes I feel these decisions are made for you. I volunteered at Memorial Hospital throughout my high school career initially believing I was going to become an OBGYN only to change to nursing after I realized the docs had no time with their patients! This was a deal-breaker for me as the patient interaction was what I desired as a practitioner. During my nursing career, I discovered there were different types of midwives and once you became a nurse you could only obtain your masters in nursing to become a midwife. So I would have had to choose to be a direct entry midwife before I went to nursing school and therefore, not gone to nursing school. However, I believe my calling was always to go to nursing school and eventually become a nurse midwife. I was given a high quality education at Frontier and do not regret my decision to go for a higher education. I believe as a nurse-midwife I am an excellent balance between medical knowledge and midwifery knowledge. I like to say my degree gives the client the best of both worlds!

  • How is a certified nurse midwife different from a certified professional midwife?

    The primary difference is in the educational pathway. Direct entry midwives (DEM’s) may have completed a formal educational program or have what is considered substantially equivalent education, which likely involves an apprenticeship with another midwife. After this they must pass the North American Registry of Midwives (NARM) written exam. Direct entry midwives may have titles such as CPM (Certified Professional Midwife) which is an additional program they have completed; and/or LDEM (Licensed direct entry midwife) or RM (Registered midwife) depending on whether their state’s process is licensure or registration. DEM’s are legal in many states but not all. In the state of Colorado, CPM’s are required to complete an accredited midwifery educational program or obtain a substantially equivalent education approved by the director in order to obtain certification. Then they must pass the midwifery examination given by the North American Registry of Midwives (NARM).

    A CNM is usually a registered nurse first. She has also completed a master’s in nursing degree at a university that specializes in midwifery education. She must then pass an exam and be certified by the American Midwifery Certification Board. This grants them the title “CNM” for certified nurse midwife which they must recertify with continuing education every 5 years. CNM’s can practice legally in all 50 states. CNM’s provide pregnancy care, primary care and women’s health care to women of all ages. They are independent health care providers. This means they consult, collaborate and refer appropriately to other health care providers when indicated but do not require any type of supervision or collaborative practice agreement.

    DEM’s in Colorado work exclusively in the home setting but in other states they can also work in birth centers. CNM’s most often work in hospitals but can also work in birth centers and in homes.

    The bottom line is that CNM’s and DEM’s are all midwives. Unlike physicians, all midwives have extensive education and training in normal female life processes such as the menstrual cycle, pregnancy, birth, and beyond. We can treat some of the abnormal or will refer appropriately if a concern is beyond our scope, but we specialize in keeping women and their family’s normal and enjoying life.

  • What do I do if I think I’m in labor?

    If you think you are in labor or your water breaks, you may call me and I will ask several questions to determine where you may be and listen as you labor. If I feel you are progressing, I will come to your home to determine if you are in active labor. This includes a vaginal exam to determine your current dilation and effacement.  The only other vaginal exams I require are if you feel the urge to push or if I suspect a variance from normal. Otherwise, my motto is to keep everything coming out and down than up and in! It is important to remember to “surrender” yourself to your labor. There may be a temptation to resist or fight it but I have found the more relaxed a mother and her support can remain, the smoother her labor is. You may choose to labor how you wish and where you wish as long as safety is maintained! I am here to help and serve you!

    You may call me at any point in your labor if you have questions or feel you may need me.

  • How do you prepare for emergencies?

    I and all of my assistants are NRP certified and trained in assisting in childbirth. We carry the necessary supplies for resuscitation of both mom and baby. We never expect the worst but always prepare for it; for this reason, I always try to have at least two assistants at every birth. At your 36 week visit, we will have your prenatal visit in your home where we will discuss an emergency plan and I will give you all the necessary numbers and contact information you may need.

    If transportation is needed, a vehicle can be used or an ambulance may be called. I will go with you to the hospital and will call ahead with all the necessary information the hospital may need to prepare for your arrival.

  • Is home birth a safe option?

    Yes, home birth is a safe option for women who are low risk and whose births have been planned to be at home as well! Currently 1% of births occur at home or in freestanding birth centers and this number is on the rise as more women choose these options over hospital birth. Home birth has grown 41% between 2004 and 2010 with 10% of the growth occurring between 2009 and 2010!

    Recently, an article was released in the Journal of Midwifery & Women’s Health by Midwives Alliance of North America (MANA) which continues to support the safety and the value of planned home birth. This article, which was release in February of 2014, covers data collected from 2004-2009 and encompasses 16,924 planned home births. Women who had planned home births had considerably fewer interventions, less augmentation or induction of labor and less operative or assisted vaginal or cesarean birth. Planned home birth was also associated with higher maternal satisfaction and is more cost-effective than hospital birth. If you like numbers, below are some of the amazing statistics from this article!

    Mothers:

    • 93.6% of the planned home births had a vaginal birth with 89.1% being completed at home
    • The transfer rate was 10.9% with primiparous women needing transfers three times as often as multiparous women
    • The top reasons for transfer were: failure to progress, desire for pain relief, fetal distress or meconium, malpresentation of the fetus and maternal exhaustion
    • The overall cesarean rate was 5.2%, the national average is 30%
    • Vacuum or forceps-assisted vaginal births was 1.2%
    • VBAC (or TOLAC) success rate was 87%, national average is 60-80%
    • 92% of VBAC’s were completed at home
    • 4.5% of mothers required oxytocin augmentation and/or epidural analgesia (compared to 26% and 67% in the US respectively)
    • 42.9% of mothers gave birth over an intact perineum, 40.9% had first or second degree lacerations
    • Only 15.5% had blood loss over 500 mL’s
    • Only 1.7% of mothers were transferred to the hospital in the immediate postpartum period; the top reasons for transfer were: hemorrhage and/or retained placenta or laceration repair
    • Only  1 maternal mortality occurred during this study at 3 days postpartum due to a blood clot found in her heart. Her pregnancy, labor, birth and postpartum up to this point were normal with normal vital signs that morning.
    • 86% of mothers were successfully and exclusively breast feeding through 6 weeks postpartum

    Newborns:

    • 92% of the newborns were full term with on 2.5% preterm (before 37 wks) and 5.1% postterm (after 42 wks); compared to the US preterm birth rate of 11.39%; compared to the El Paso County preterm birth rate of 10%
    • 74% of newborns were normal weight range with fewer than 1% being low-birth weight and 25% being macrosomic (>4000 g); compared to US low birth weight rate of 8.02%; compared to El Paso County low birth weight of 9.8%
    • The transfer rate for newborns born at home was 1%; the top reasons for transfer were: respiratory distress and/or Apgars scores below 7, the rest of the transfers were for suspected congenital anomalies
    • 2.8% of newborns were admitted to the NICU during the 6 weeks following birth
    • When lethal congenital anomaly deaths were removed, the intrapartum fetal death rate was 1.3/1000, the early neonatal death rate was 0.41/1000 and the late neonatal death rate was 0.35/1000. Compared to the US neonatal mortality rate of 4/1000; compared to neonatal mortality rate of 3/1000 in El Paso County

    Overall, these findings are consistent with the research that shows that planned home birth is safe for healthy, low-risk women when attended by a midwife which results in positive outcomes and benefits for both mom and baby!

    Citation:

    Cheyney, M., Bovbjerg, M., Everson, C., Gordon, W., Hannibal, D., & Vedam, S. (2014). Outcomes of care for 16,924 planned home births in the United States: The Midwives Alliance of North America statistics -project, 2004-2009. Journal of Midwifery & Women’s Health, 59(1), 17-27.

    El Paso County Births and Deaths. (2013). Selected birth characteristics. Retrived from http://www.chd.dphe.state.co.us/Resources/vs/2013/El%20Paso.pdf.

    The World Bank. (2015). Mortality rate, neonatal  (per 1,000 live births). Retrieved from http://data.worldbank.org/indicator/SH.DYN.NMRT.

    U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics, & National Vital Statistics System. (2015). Births: Final data for 2013. National Vital Statistics Reports, 64(1), 1-65.

  • Do you provide waterbirth services? Is it safe to have a water birth?

    Yes and yes! Waterbirth is a beautiful, gentle transition to the world for your little one! Please see the article below on waterbirth in the US!

    The Journal of Midwifery & Women’s Health released a study in June 2014 whose sole purpose was to evaluate the safety of waterbirth. The study not only validated the safety of waterbirth but even on many aspects proved that the outcomes of waterbirth may be equivalent , if not improved, among women who are low risk and healthy, when compared to land birth! Waterbirth is associated with greater maternal satisfaction, increased likelihood of an intact perineum, decreased incidence of lacerations or episiotomy use and reduced postpartum hemorrhage. Here are some of the stats:

    • No difference in maternal infection rates between land or water births
    • Reduced analgesia use with water labor and birth; reduced pain perception with water labor and birth
    • No difference in 1 and 10 minute Apgar scores between water birth and land birth and 5 minute Apgar scores (the most important score when determining long term outcomes) were either equivocal or improved in water birth versus land birth!
    • Waterbirth is associated with equivocal or improved umbilical cord pH
    • Cord avulsion occurred at 2.4/1000 water births
    • There was no difference between neonatal infection rates between water birth and land birth
    • There was no differences in NICU admission rates  when comparing water birth and land birth

    While there are risks to water birth these risks seem to be minimal and are comparable (if not improved) to conventional or land birth. Waterbirth supports the midwifery model of care and the client-midwife relationship while maximizing the opportunity for physiologic birth. If you would like more information on water birth, please feel free to talk to me, I would love to answer your questions!

    Citation:

    Nutter, E., Meyer, S., Shaw-Battista, J., & Marowitz, A. (2014). Waterbirth: An integrative analysis of peer-reviewed literature. Journal of Midwifery & Women’s Health, 59(3), 286-319.