Not Just Birth Coaches
In addition to being registered nurses, CNMs have spent one to two years acquiring clinical midwifery skills. While a few go on to get advanced obstetrical training, most CNMs deal exclusively with the 80 to 90 percent of women whose pregnancies are considered low-risk. (High-risk pregnancies include those in which the woman is carrying two or more babies, has a history of preterm labor, or suffers from a condition such as diabetes, heart disease, or severe hypertension.) And although they're best known for supervising childbirth, CNMs also receive training in prenatal and well-woman care, which covers gynecological exams, Pap smears, and counseling on everything from lactation to contraception to menopause.
Because of their overall approach, however, midwives are more than stand-ins for doctors. "Obstetricians have been taught that pregnancy and labor are disasters waiting to happen," says Bruce Flamm, M.D., an obstetrician at Kaiser Permanente in Riverside, CA, who often argues the case for CNMs to the medical establishment. "That means that OBs tend to use more medical interventions and pay less attention to the emotional concerns of women." Midwives, on the other hand, offer a more thorough and compassionate type of care, Flamm adds.
In addition to covering the prenatal basics -- monitoring weight and blood pressure, listening to the fetal heartbeat -- some midwives provide information about nutrition and exercise as well as alternative therapies for childbirth pain relief such as acupuncture and homeopathy.
They also take an interest in the personal lives of their patients. Deborah Shurman, a mother of four in Augusta, ME, recalls a prenatal appointment during which she was particularly upset. "The midwife took my blood pressure, frowned, and then took it again," says Shurman. "Then she leaned forward, put her elbows on her knees and asked me outright, 'What's happening in your life? Let's talk a bit.'" At that point, Shurman burst into tears and started talking a real blue streak. "My husband had left me just a few days before," she explains, "and it was a very difficult period. The midwife reminded me to take time for myself and to look after my own needs, too."
Even a midwife's office may look different from that of the typical obstetrician. Catherine Gorchoff, a CNM in Santa Rosa, CA, decorated hers with antiques, floral paintings, and scented candles to mask any medicinal odors. "Making my office look different is one of the ways I try to set a healthy outlook on the whole pregnancy," Gorchoff explains.