Frequently Asked Questions
Q: What is a Certified Nurse-Midwife?
A: Today’s Certified Nurse-Midwife, (CNM) is a professional health
care provider. Her initial degree was as a registered nurse (RN) who has
furthered her education by graduating from a University based, advanced
program accredited by the American College of Nurse-Midwives. In addition,
nurse-midwives must pass a national certification examination and meet
strict requirements set by state health agencies and may not practice Midwifery
in that state without a license.
Q: Where do CNM’s work?
A: Nurse-Midwives work predominately in clinics and hospitals. Many
work in private practices with physicians, employed by Health Maintenance
Organizations (HMO’s) or work for a University Medical Center,
like the University of Michigan nurse midwives.
Q: What services do CNM’s provide?
A: Nurse-Midwives provide prenatal, birth, postpartum and normal
newborn care. They also provide routine gynecological care, which includes
family planning services, yearly health maintenance examinations, care
of the woman during menopause and the treatment of minor gynecologic
disorders such as vaginitis. They are probably best known for how they
help women during labor and delivery, but they apply their philosophy
of care in all settings and with women across their lifespan.
Q: Is Midwifery care safe?
A: According to Public Health Reports issued in 1997, “Midwifery
has a good track record with regard to quality of care; it represents a
good value for health care dollars; and it rates high in client satisfaction.” The
American Academy of Science’s Institute of Medicine also reported
that Certified Nurse-Midwives are highly effective in managing the care
of pregnant women, resulting in fewer premature and low birth-weight babies.
At the University of Michigan, the Nurse-Midwifery Service has a cesarean
section rate of 14 percent, compared to a national rate of 25 percent.
Also, our vaginal birth after cesarean success rate is 75 percent compared
to the national average of 25 percent. We believe these positive outcomes
are due to our selective use of interventions, our support of women during
pregnancy and labor and our excellent collaboration with our OB colleagues.
Frequently Asked Questions Regarding the University of Michigan Nurse-Midwifery Service
Q: Where will I have my baby? Can I have my baby at home?
A: We work exclusively out of the Women’s Hospital Birth Center.
Our unit provides single room maternity care. Therefore you labor, give
birth and then stay in the same room until discharge, while a single nurse
cares for you and your baby. At this time we are unable to take care of
women planning a home birth.
Q: Will the midwife I see in clinic deliver my baby?
A: We are a group practice; therefore any member of the service might
be with you for your birth. We practice this way for several reasons.
First, it is very exhausting being on-call 24/7. We do not believe it
is safe to deliver babies when you are over-extended in this way. Secondly,
many of us have other responsibilities that prevent us from providing
this type of care. We all have teaching, community and family responsibilities
in which our expertise and presence is important. As a group, we meet
monthly to discuss our patient’s needs and desires for their birth.
We work hard at being philosophically in the same place so that you do
not have to “re-negotiate” your birth plan with each individual
midwife.
Q: Will my insurance pay for Nurse-Midwifery care?
A: Most insurance companies will pay for Nurse-Midwife care. The
major insurers in this area, M-Care, Medicaid and most BCBS plans pay
for Midwifery care. (If you have BCBS, there are a few plans within that
system that will not pay, so we encourage you to call and verify). If
you call and ask your insurance company if they pay for Midwifery care,
be sure to specify you will be delivering in the hospital. Also, if they
say no, ask if they pay “incident to”, which essentially
means they bill through the hospital, not the individual midwife. Many
patients have thought that their insurance would not pay for Midwifery
care, when they actually will.
Q: I want a totally natural birth. I am concerned that if I deliver in
the hospital, this is not possible.
A: We are very supportive of your desire for a natural birth. We
will work hard with you to accomplish this and believe interventions should
be used wisely and appropriately. We feel that we are partners in your
care and will listen to your needs and desire. At times however, birth
does not go as one desires. It is our job to guide you through this difficult
path, making recommendations as needed. Our OB colleagues are very respectful
of our practice, and we have an excellent working relationship. They will
only become involved in your care if we consult with them.
Q: I would like Midwifery care, but would also like an epidural. Can I
still see a Midwife?
A: Definitely. Our motto is “Listen to Women” and if this is
a strong desire on your part, we feel it is our role to support you
in these decisions.
Q: Do I have to have an IV? What about an episiotomy
or continuous fetal monitoring?
A: Each intervention is evaluated on its own merit as we assess how
to provide you safe care. There are indications for each of these
measures. If you do not meet these indications, you will not receive them.
When you arrive in labor and delivery, we will place you on the monitor
for a period that averages 20-30 minutes. Once we are reassured your baby
is tolerating labor well, we encourage you to be up walking, showering
or on a birth ball. Episiotomies are rarely done. Last year only 2% of
our patients received an episiotomy.
Q: I know U-M is a teaching hospital. Will I have a lot of students
at my birth?
A: No. However we do teach midwifery students from the U-M. They
may be involved in your care but in general, for most deliveries,
there is just you and your support people, the midwife and nurse.
At times, other students (nursing, medical students) ask to be present
at one of our births. We would always ask you if this was acceptable.
If you say no, we respect that.
Q: Can I labor in the tub? Birth in the tub?
A: We have 3 tub rooms and access is first come first serve. The
charge nurse tries to leave these rooms open for our patients, but it
is not a guarantee there will be one available when you arrive in labor.
We will do waterbirths as long as you do not have any risk factors. This
would be something you would discuss with your midwife in clinic before
labor.
