A fair question, a misunderstanding

When you have military anything, insurance included, everyone else who has it is nosy as hell about what you're doing. I mentioned something in the context of conversation about Alyson's low transfer rate and almost nonexistent c-section rate, and said only half jokingly, "Well, that's why we pay her the big bucks!" (In reality, the bucks really aren't that big.) The first thing out of anyone's mouth was, "Well I had a midwife for my birth, and Tricare covered it! Why don't you find one that Tricare covers!" The short answer? Because I like this one, because I think that when you meet the person who's meant to assist you with your birth, you know deep down that it's right, and I knew immediately that Alyson is the one for us. I've never been more certain of anything since the day I met Nancy who assisted me with Orren's birth. That's why I won't find one Tricare covers. (Sometimes you get lucky... Tricare covered Nancy's services. They don't always cover Alyson's. That's just the way it is. I don't let my insurance's list of providers dictate my birthing choices, and nobody else should either!)

The long answer is that that's actually a really fair question, and has a really detailed answer, which anyone who's of childbearing years should probably read. I'm a believer in all moms, or potential moms (dads, too!) knowing their options, and having a jumping off point for learning what's out there, so here you go. Here is a quick and dirty rundown of the different types of midwives who practice in the US. Insurance approved CNM's are barely the tip of the iceberg.

If you had a hospital birth with a midwife, she was a Certified Nurse Midwife, a CNM. Many people think they are basically the gold standard when it comes to midwifery, and depending on what you're looking for, that may be true. CNM's are nurse practitioners who have gone on to advanced training in midwifery. They can do most anything a doctor can do. They can prescribe you medicine, and even admit you to the hospital and be your attending care provider while you're there. This is excellent if you have the right CNM. For someone like me, who does not want a hospital birth, the right CNM is one who practices out of hospital, and has a low transfer rate (anything much over 6% would alarm me). The problem is that a lot of CNM's these days, have become WAY too medical, and are hardly any better than an OB. There are still some great ones out there, but it's become very hit-or-miss, so if you're interviewing CNM's, ask the tough questions. Proceed if you love what you hear.

I've had two births with CNM's. One of the births was great. The other proved that if you take even a good CNM, who would help you have a great birth in any other setting, and put her in a hospital, there really isn't much she can do for you because policy has tied her hands just as much as it has tied yours. The moral of the story is that the location of birth is as important as the practitioner who's assisting. CNM's can put you in the hospital. You want to make sure yours won't do that unless it's a life or death emergency. On the positive side, EVERY insurance policy will cover birth with a CNM.

Most other midwives who are not CNM's are classified as Direct Entry midwives. That means they did not go to nursing school first. Now, there are several classifications.

Certified Professional Midwives, CPM's, have gone to midwifery school, passed national licensing exams (That is what grants the CPM suffix), and then, in most states (including TX) they have to pass additional licensing exams for the state to license them. After they do that, they are LM as well as CPM. I am currently receiving care from an LM, CPM. In this city, and a lot of other places, if you want to birth outside of a hospital, you will do it with an LM or an LM, CPM. The approach differs from a CNM in that it is far less medical. There is very little testing involved, and the focus is on preventing bad things from happening holistically, rather than treating what does happen. A CPM cannot write prescriptions, but can administer certain prescription medication during labor, delivery, or postpartum. This is outlined in each state's midwifery laws. Know thy laws before choosing thine practitioner. It varies state to state. If you transfer to the hospital, your CPM can go with you to advocate for you and support you, but in the hospital, she cannot be your attending practitioner. However, CPM's have a far greater scope of practice than most CNM's. Things a CNM would transfer somebody for, a CPM will know how to handle at home. Most CPM's have a lower transfer rate than CNM's do, and just as great of outcomes for moms and babies. (In fact, some of the best maternal/infant outcomes in the world come from The Farm Midwifery Center in Tennessee. Their midwives are CPM's.) There is nearly no insurance on the planet that will cover birth with a CPM unless you really know what buttons to push.

Sometimes you also see LM's who are not CPM's. Every one of these I've ever met did her midwifery school in a different country (and is from that country), so she has her own country's equivalent of a CPM designation, but it's not noted here in the US. The LM designation notes that she has passed the state's licensing requirements. LM's run things almost exactly the same as CPM's do. They work in birth centers and homes. Insurance does not often cover their services without a fight either.


There is also another category that's not often talked about, which is commonly known as "lay midwives" or "traditional midwives". They are women who attend births, but do not have any form of licensing. Legally, they can't administer the medications LM's and CPM's can, but most get them anyhow, which I think is good, for their clients' sake. They never work in birth centers, only in homes, and are most commonly found in states where it is illegal to practice midwifery, and there is no state licensing exam to be had. Since this is an underground industry, obviously there would be no insurance coverage for lay or traditional midwifery services.


As you may see, there is a lot more to the story than choosing the random name of a CNM off the insurance company's approved providers list. It is a spectrum that ranges from CNM's who act like OB's, all the way to traditional midwives whose names you cannot list on your child's birth certificate because their services are illegal in most states. I've always liked being near the center, either with a CNM who practiced a bit like some CPM's, or now, with a CPM who takes a very easy going approach. I seem to prosper in the middle of this spectrum. You have to find where you want to be. Let your priorities, your mind, and your heart be your guide, but never your insurance company's list.