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CPM - Certified Professional Midwife - Dump Information

Vendor : Medical
Exam Code : CPM
Exam Name : Certified Professional Midwife
Questions and Answers : 40 Q & A
Updated On : December 14, 2018
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CPM Questions and Answers

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CPM Certified Professional Midwife

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CPM exam Dumps Source : Certified Professional Midwife

Test Code : CPM
Test Name : Certified Professional Midwife
Vendor Name : Medical
Q&A : 40 Real Questions

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Medical Medical Certified Professional Midwife

Midwives eye next hurdle to supplying infants in Alabama | killexams.com Real Questions and Pass4sure dumps

a group of Alabama legislators will meet nowadays to investigate the fate of domestic-birth midwives, as a minimum for the close future.

closing yr, the state legislature handed a bill, later signed into legislation, that would permit accepted midwives to attend home births in Alabama for the primary time in additional than 40 years.

however Alabama women can’t hire those midwives yet. The law says licensed skilled midwives – which carry children in out-of-medical institution settings and legally apply in about 33 other states – can now practice for a license to follow in Alabama.

earlier than that can turn up, the Board has one final hurdle: getting its guidelines and rules authorised with the aid of the Legislative Council.

The Council, made up of state representatives and senators, will hear arguments these days from proponents and opponents of the proposed suggestions which would govern how domestic-delivery midwives can operate.

“If (the Legislative Council) accepts the guidelines and regulations, we are able to circulate forward and begin the procedure of accepting purposes and issuing licenses for certified professional Midwives,” observed Kaycee Cavender, a member of the Board of Midwifery. “if they reject them, we definitely start everywhere.

“We have been instructed via the lawyers for the Legislative Referral functions that if it fails, we don't seem to be legally competent to do anything else with the suggestions and regulations unless after the 2019 legislative session.”

If that’s the case, it may be June 2019 or later earlier than the Council might examine a new set of suggestions and rules.

“So it could be yet another eight months as a minimum that moms have to wait to get entry to certified professional Midwives,” spoke of Cavender, “however this legislations turned into passed closing year.”

professionals and cons

The Board of Midwifery faces robust pushback from historical opponents: clinical organizations around the state representing medical doctors, hospitals and other scientific suppliers who fought the passage of remaining year’s law.

most of the businesses have been closely involved in the drafting of the proposed guidelines.

one of the vital lively has been the medical association of the State of Alabama (MASA), knowledgeable company that represents Alabama physicians.

Mark Jackson, MASA’s executive director, stated he had some predominant concerns with the rules and regulations the Board will latest at today’s meeting.

a type of is the suggestion to permit midwives to administer certain prescription medication to their patients.

“We didn't think that turned into acceptable and don’t believe that’s allowed by using statute,” said Jackson. “We pointed that out to (the Board) in our conversations and former conferences, however that language stayed within the guidelines.”

Cavender argues that the legislation doesn't certainly say the Board can authorize midwives to dispense definite medicines, however that it did supply the Board authority to create guidelines and rules which are according to instructions created by the North American Registry of Midwives.

Cavender additionally mentioned the Board believes the guidelines would no longer violate the Alabama managed substances Act because the definite prescription medicine allowed within the midwife laws are non-narcotic.

one other challenge that might bog down the passage of the midwife regulations offers with newborn care.

“The rules and laws state the midwife is able to care for the new child for up to six weeks after start,” said Cavender. “Midwives are expert to supply new child care. It’s part of their scope of practice.”

Jackson disagrees.

“actually they look after the newborn automatically after the beginning,” he noted, “however in a fairly short period of time, that care needs to be turned over to a pediatrician.”

Dr. Wes Stubblefield, president of the Alabama Chapter of the American Academy of Pediatrics, talked about in an announcement that his corporation “strongly opposes the rules as written, particularly concerning the care of newborns six weeks after beginning.

“we are working with a coalition of businesses it is submitting substitute rules to the legislature for consideration,” said Stubblefield.

Coalitions

Cavender said the Board has “worked very challenging to be inclusive of clinical corporations and enable them the opportunity to voice their concerns so we could address them.”

“It’s just wrong that these scientific companies proceed to defeat our rules and rules and block them within the name of the security of mother and babe, and in the meantime, our child mortality price continues to be one of the vital worst within the nation,” she stated. “Why are we not making a confirmed fitness issuer purchasable in Alabama?”

She faults the medical organizations for influencing legislators on the Legislative Council.

Sen. Jim McClendon, R-Springville, is a member of the Legislative Council and the chair of the Senate health & Human features Committee. He said elements of the proposed rules “appear to be” inconsistent with the bill that legislators handed ultimate 12 months.

“those guidelines must be in keeping with the statute that authorizes that company to exist,” he said. “If there are areas that look contrary to the statute – opposite to what the law allows – then that’s no longer decent. You’ve obtained to reside within the legislation.”

The prescription drug subject become one certain sticking element, he noted.

“We’ll see what happens,” he noted. “I’m no longer going to predict what’s going to happen.”

An Alabama nurse heads for the state line


what's a midwife? How americans become midwives, and how to select one | killexams.com Real Questions and Pass4sure dumps

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Nov. 2, 2018 / four:fifty two PM GMT/ source: these days

by means of Meghan Holohan

As a scholar at Brown institution in windfall, Rhode Island, within the Nineteen Eighties, Afua Hassan dreamed of becoming an obstetrician. however her profession took a sudden flip after an sudden assembly.

“I had been considered in a sanatorium someday through a midwife and that i referred to, ‘I need to be a midwife,’” the Houston-based midwife instructed today. After graduating with a level in African American experiences, Hassan pursued midwifery and has been training for 35 years.

Hassan is a direct entry midwife, also recognize as a licensed knowledgeable midwife (CPM). CPMs don't seem to be recognized in all 50 states, however Texas is one in every of 31 states that recognizes them, according to the American college of Nurse Midwives (ACNM). A CPM is an impartial midwifery practitioner who has met the requisites for certification set via the North American Registry of Midwives.

Hassan attended the Houston school of Midwifery for 3 years, which blanketed shadowing and assisting a midwife. For 10 years, she assisted others before finally beginning her personal apply in Houston.

In 2011, Hassan situated the Birthing vicinity, a women's fitness middle providing smartly girl care, fertility consultations, prenatal, delivery and postnatal services. whereas girls can deliver at the Birthing location, Hassan also offers domestic births with experienced midwives from her apply.

CPMs are considered one of three distinctive types of midwives. The training they have, where they could apply and what features they present varies. but most americans don’t be aware the change. To them, a midwife is a midwife.

“When ladies are making decisions about searching for midwifery care, they don’t ask the questions about what class of midwife you are, what are your credentials and how have you been licensed,” noted Erin McMahon, college observe director and assistant professor of nurse-midwifery and ladies’s health at Yale college school of Nursing. “All ladies should still be curious and ask questions a couple of midwife’s practicing and their degree of experience.”

Direct entry midwife or licensed professional midwife

Direct entry or licensed knowledgeable midwives (CPMs) are a greater community-primarily based approach to midwifery, the place people attend some classes, however learn through shadowing and apprenticing with different midwives. Most CPMs focal point solely on prenatal and postnatal care. Hassan discovered midwifery this fashion.

“it is like an apprenticeship model. A pupil would work with one other midwife often in the home and sometimes in a delivery center. They strengthen their potential with schooling and with the aid of working with their preceptors,” McMahon defined.

CPMs usually tend to attend domestic births and infrequently do not have privileges in hospitals. while they can not prescribe treatment, they generally work intently with physicians. it truly is how Hassan obtains pregnancy-linked remedy, such as Pitocin (used to result in labor), for her sufferers.

while she's often allowed to live and assist the mom if she's transferred to the medical institution, attending a health facility delivery can suppose isolating. not all doctors welcome her or other CPMs. but she advocates for her patients in spite of the fact that she will be able to’t proceed assisting with birth.

“i am not their healthcare company, however i am giving all of the information the medical doctors want and that i reside except the child comes,” Hassan noted.

certified nurse midwife

a certified nurse midwife (CNM) has a bachelor's degree in nursing and master’s degree in nursing midwifery. CNMs can apply in all 50 states and they can prescribe drugs, in line with ACNM. while CNMs carry little ones, they additionally deliver care to girls all the way through their lives.

“we're lifetime healthcare providers. We supply contraception, gynecological functions,” Shadman Habibi, director of the nurse-midwives application at UCLA scientific center, Santa Monica, advised nowadays. "we can administer hobbies care."

CNMs most commonly apply in hospitals or birth centers, though some participate within the 1 % of home births that take area in the u.s..

“the vast majority of births in the U.S. are in hospitals and that's the place you'll locate the vast majority of CNMs,” mentioned McMahon.

certified midwife

a certified midwife (CM) has a graduate degree in midwifery from a program certified by means of the Accreditation fee of Midwifery training, but doesn't have a bachelor's degree in nursing.

Like CMNs, CMs apply in hospitals and delivery centers but can handiest prescribe medicine in certain states. consistently, CMs have shut relationships with physicians who can prescribe medicine obligatory for their sufferers.

The ACNM includes CMNs and CMs in its ranks. The American school of Obstetricians and Gynecologists (ACOG) works carefully with CMNs and CMs. based on a coverage statement, ACOG and ACNM recognize the importance of collaboration:

“Shortages and maldistribution of maternity care clinicians cause critical public health concerns for ladies, children, and families … ACOG and ACNM suggest expanding the variety of OB-GYNs and CNMs/CMs, making use of inter-professional education to advertise collaboration and crew-primarily based care."

Emergency care throughout settings

The overwhelming majority of births within the U.S., ninety nine %, ensue within hospitals or beginning facilities. beginning facilities may also be affiliated with hospitals or universities or they will also be neighborhood-primarily based, like Hassan’s middle.

The commission for the Accreditation of delivery facilities offers accreditation for delivery centers that adhere to their standards. rules on developing a birth middle vary from state to state and a few states make it cost prohibitive to open a start center, Hassan mentioned.

whereas start is constantly uneventful, emergencies can happen in any atmosphere. Hospitals use standardized practices to handle emergencies.

“we have protocols in California,” Habibi, who works at the UCLA clinical center, stated. “every person is aware of the steps. We discuss it. we have drills for obstetric emergencies.”

birth facilities and CPMs also have plans for emergencies or transfers to a clinic. Hassan has a 7 % switch rate and he or she knows precisely what to do if a mother must go to the medical institution.

“i'm five minutes far from the biggest scientific core,” she mentioned. “either we get in the motor vehicle or we will take the ambulance reckoning on the condition. I have the patient’s statistics. I clarify what's occurring.”


Empowered by using her personal home start, Deanna Kopf grew to be a midwife, started Birthwise Midwifery in Catonsville | killexams.com Real Questions and Pass4sure dumps

When Deanna Kopf was pregnant with her third baby in 1989, she planned to use a midwife for a natural start at home. but these plans didn’t go rather as anticipated and she or he and her husband ended up supplying their son themselves.

“He got here very quickly and my midwife didn’t make it in time — it turned into simply me and my husband,” talked about Kopf, of Hampstead, Md. “That became the reassurance that my body knew a way to do it and the child knew the way to be born. It was very empowering and made me want to exit and let different americans have the same experience.”

these days, Kopf, 50, is a certified professional midwife (CPM) and has had her own apply, Birthwise Midwifery, in Catonsville for eight years. Her resolution to become a midwife became actually born after that home delivery of her third child, son Trevor, now 11. Her other two infants were born in a hospital.

according to a Reuters health record in 2016, at-domestic births have become more common within the U.S. The figures from a 2014 study by using the Maryland population research middle at the institution of Maryland in faculty Park, stated that out of pretty much 60,000 out-of-sanatorium births throughout the U.S., 38,000 were home births, and 18,000 took region at birth facilities.

Kopf talked about it took her about five years to develop into a CPM and to work on her personal. Her practising became more often than not online and self-look at, and he or she additionally needed to attend births — working, observing and assisting another CPM.

She is registered with the North American Registry of Midwives, which certifies midwives for out-of-medical institution births. She aspects out that she is not an authorized nurse midwife or CNM, who've nursing degrees, specialise in midwifery and work in hospitals and beginning centers.

Most midwives in center of state

presently, there are most effective 15 CPMs within the state of Maryland. in keeping with the Maryland Board of Nursing, there are 269 CNMs in Maryland.

“We range in age from late 20s to 70s for these licensed,” observed Jan M. Kriebs, CNM, adjunct professor on the Midwifery Institute at Jefferson university in Philadelphia. She noted most of the CNMs who follow are predominantly in hospitals; the relaxation are in start centers and home deliveries.

“the majority of midwifery practices are within the core of the state, from Frederick to Baltimore to Southern Maryland—and there are some on the japanese Shore and north of Baltimore,” Kriebs stated in an email.

Harford's only midwives team celebrates 10,000th birth at Upper Chesapeake

The beginning of Margo Powell's 2d child turned into a tons distinct journey than her first. Powell had hypertensive considerations while giving delivery to her older daughter, Erin, two years in the past, and Powell noted her doctor became unceremonious in coping with the beginning.

"My first beginning become relatively worrying. It felt...

In 2015, Maryland passed a law allowing CPMs to apply legally. before that, simplest a CNM turned into allowed to support in a house beginning; most CPMs had to work under the radar, Kopf observed.

There are strict instructions for CPMs. They can't perform cesarean sections or attend a vaginal birth after a cesarean. They can't carry twins, breech births or if the mom has preeclampsia, a situation brought about through high blood pressure. They can't prescribe medication but can lift oxygen and Pitocin, which is used to induce labor.

“we've a lower percent of intervention prices and C-part prices with domestic births,” Kopf talked about. “we're experts in normal delivery.”

She stated that emergencies are rare but they do transfer to a clinic if some thing had been to take place.

“Our transfer rate [to a hospital] is set 5 %,” she noted.

at the moment, Maryland doesn't require CPMs to carry liability assurance and Kopf observed most CPMs do not have it. She spoke of that they practice with the total-and-informed consent of their shoppers, going over the dangers and advantages of a home delivery.

“There’s lots of have faith between us and our clients,” she said.

corporations such as the Midwives Alliance of North American, or MANA, promote the practice of widwifery.

Vicki Hedley, president of MANA, has been a midwife for 11 years and mentioned the corporation works to aid states toward legalizing CPMs. They additionally host conferences, workshops and support midwives community.

“We try to promote midwifery and to create entry to midwives,” Hedley stated.

Of equal significance to MANA, Hedley stated, is to have extra range within the container and to get states so as to add midwife services to Medicaid.

“The low repayment prices keep midwifery out of the lower-income group. The general repayment is ready $328,” referred to Hedley, regarding these CPMs who settle for Medicaid. presently, Maryland Medicaid doesn't cowl domestic birth functions.

Having a house birth is regarded an out-of-pocket fee and isn't always reimbursed by means of assurance. Kopf costs $3,900 per birth.

Birthing centers provide alternative for expecting moms

For expectant moms who don’t are looking to convey their babies in a medical institution, birthing middle are one more option. Shaina French, is a certified nurse midwife with Anne Arundel clinical neighborhood Bay enviornment Midwifery, a freestanding birth core discovered on the leading health facility campus of Anne Arundel clinical middle...

‘difficult’ and ‘euphoric’

With more than 600 births below her belt in her solo practice, Kopf additionally trains other girls to turn into midwives. one among her newbies, Tova Brody, 27, used Kopf as a midwife for all 4 of her pregnancies. Brody referred to she had at all times been drawn to natural childbirth and got involved within the activism side of midwifery working with the corporation Maryland households For secure Births, after the birth of her first daughter. nevertheless it become the beginning of her fourth infant, Shifra Brody on June 7, and her journey with Kopf that caused her to enter the field.

lately, while her newborn daughter slept in her hands, Brody explained her direction to fitting a midwife. “It was like meeting a grandmother,” she said about Kopf. “She changed into somebody intelligent and loving; she had complete believe within the birthing system. I knew this became some thing i needed to be part of. It empowers girls,” Brody pointed out.

Fletcher and Lexi Cunif, who live in Catonsville, anticipated they'd have their first child in a clinic. but however Lexi, 27, is a nurse, she wasn’t certain the health center adventure was for her. Fletcher, 40, stated he and his more youthful brother had both been born at home, and their more youthful sister became born at a birthing core. After an initial appointment with Kopf, the Cunifs determined to forgo the medical institution beginning and have their child at domestic.

To put together themselves for the upcoming birth, the couple attended deepest birthing courses in Pikesville with a doula — somebody who specializes in beginning coaching — whose uniqueness is in hypno-birthing, a philosophical approach to childbirth that teaches leisure, special respiratory and meditation during the birthing manner. They also hired the equal doula to support in Lexi’s labor.

“My spouse became 52 hours in labor. There’s simplest so a great deal practise that you can have until now,” he stated of the journey. He noted he was grateful that the doula become on hand to help instruct him and to give undivided attention to his spouse.

“It became a surreal, prolonged sleepover,” he referred to laughing. “there have been 5 of us crammed into the bed room.”

When their baby daughter, Brynn, eventually made her look, Fletcher stated it changed into a euphoric moment for him.

“As difficult because it become, we have been in reality chuffed to have achieved this at home—i can’t thank them satisfactory,” he spoke of of Kopf, Brody, and their doula.

‘peaceable feeling at home’

Kopf noted she has had valued clientele who prior to now had hospital births they weren’t chuffed with. They pointed out they didn’t want all of the medical intervention and didn’t like no longer being in a position to make choices themselves.

“They want the sensation they are worried and want that peaceful feeling at home,” Kopf talked about.

Kopf pointed out she likes to spend loads of time together with her consumers, and constantly most effective takes on three to 5 purchasers per 30 days. She noted she does get a distinct latitude of people in different ranges of their being pregnant, however most new valued clientele are between 10 and 12 weeks into their pregnancy.

The time she spends with them additionally contains put up-beginning, where she stays with the mother and newborn for a number of hours after start. She follows up once more 24-48 hours in a while, then sees them once more up through six weeks.

“Taking too many customers capability I wouldn’t get to spend lots of time with them,” Kopf pointed out.

Kopf stated clients decide what trend of delivery they want. Some may additionally decide upon their mattress, however the use of a bathtub, which Kopf provides, appears to be a popular option.

“They name the tub ‘nature’s epidural’; it feels weightless and lessens labor pains,” she said.

Kopf and Brody don’t whitewash the incontrovertible fact that having a child naturally will damage, but they accept as true with that being at domestic and allowing nature to take over is a fine looking and herbal journey.

“If labor is uninterrupted, it increases the intensity that the physique can address,” Brody pointed out. “The ache is rarely greater than you since it is you; women can trust their bodies.”

Midwives, including Kopf, additionally work with masseuses, acupuncturists, chiropractors and doulas to assist their purchasers throughout the start method.

“We do encourage them to rent a doula,” she spoke of. “We also motivate them to eat and drink while in labor.”

Kopf spoke of there aren't any common situations with a home beginning; some are brief labors and a few will also be long. She’s attended births that took lower than one hour and these days attended a delivery that took 4 days.

“She turned into a trooper,” Kopf referred to.

both she and Brody observed that each beginning is moving.

“I still cry,” Kopf talked about.


CPM Certified Professional Midwife

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CPM exam Dumps Source : Certified Professional Midwife

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Certified Professional Midwife

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Empowered by her own home birth, Deanna Kopf became a midwife, started Birthwise Midwifery in Catonsville | killexams.com real questions and Pass4sure dumps

When Deanna Kopf was pregnant with her third child in 1989, she planned to use a midwife for a natural delivery at home. But those plans didn’t go quite as expected and she and her husband ended up delivering their son themselves.

“He came very fast and my midwife didn’t make it in time — it was just me and my husband,” said Kopf, of Hampstead, Md. “That was the reassurance that my body knew how to do it and the baby knew how to be born. It was very empowering and made me want to go out and let other people have a similar experience.”

Today, Kopf, 50, is a certified professional midwife (CPM) and has had her own practice, Birthwise Midwifery, in Catonsville for eight years. Her decision to become a midwife was literally born after that home birth of her third child, son Trevor, now 11. Her other two children were born in a hospital.

According to a Reuters Health report in 2016, at-home births are becoming more common in the U.S. The figures from a 2014 study by the Maryland Population Research Center at the University of Maryland in College Park, stated that out of almost 60,000 out-of-hospital births across the United States, 38,000 were home births, and 18,000 took place at birth centers.

Kopf said it took her about five years to become a CPM and to work on her own. Her training was mostly online and self-study, and she also had to attend births — working, observing and assisting another CPM.

She is registered with the North American Registry of Midwives, which certifies midwives for out-of-hospital births. She points out that she is not a certified nurse midwife or CNM, who have nursing degrees, specialize in midwifery and work in hospitals and birth centers.

Most midwives in center of state

Currently, there are only 15 CPMs in the state of Maryland. According to the Maryland Board of Nursing, there are 269 CNMs in Maryland.

“We range in age from late 20s to 70s for those licensed,” said Jan M. Kriebs, CNM, adjunct professor at the Midwifery Institute at Jefferson University in Philadelphia. She said most of the CNMs who practice are predominantly in hospitals; the rest are in birth centers and home deliveries.

“The bulk of midwifery practices are in the center of the state, from Frederick to Baltimore to Southern Maryland—and there are some on the Eastern Shore and north of Baltimore,” Kriebs said in an email.

Harford's only midwives team celebrates 10,000th birth at Upper Chesapeake

The birth of Margo Powell's second baby was a much different experience than her first. Powell had hypertensive issues while giving birth to her older daughter, Erin, two years ago, and Powell said her doctor was unceremonious in handling the delivery.

"My first birth was pretty traumatic. It felt...

In 2015, Maryland passed a law allowing CPMs to practice legally. Before that, only a CNM was allowed to assist in a home birth; most CPMs had to work under the radar, Kopf said.

There are strict guidelines for CPMs. They cannot perform cesarean sections or attend a vaginal birth after a cesarean. They cannot deliver twins, breech births or if the mother has preeclampsia, a condition brought about by high blood pressure. They cannot prescribe medication but can carry oxygen and Pitocin, which is used to induce labor.

“We have a lower percentage of intervention rates and C-section rates with home births,” Kopf said. “We are experts in normal birth.”

She said that emergencies are rare but they do transfer to a hospital if something were to happen.

“Our transfer rate [to a hospital] is about 5 percent,” she said.

Currently, Maryland does not require CPMs to carry liability insurance and Kopf said most CPMs do not have it. She said that they practice with the full-and-informed consent of their clients, going over the risks and benefits of a home birth.

“There’s a lot of trust between us and our clients,” she said.

Organizations such as the Midwives Alliance of North American, or MANA, promote the practice of widwifery.

Vicki Hedley, president of MANA, has been a midwife for 11 years and said the organization works to help states toward legalizing CPMs. They also host conferences, workshops and help midwives network.

“We are trying to promote midwifery and to create access to midwives,” Hedley said.

Of equal importance to MANA, Hedley said, is to have more diversity in the field and to get states to add midwife services to Medicaid.

“The low reimbursement rates keep midwifery out of the lower-income community. The average reimbursement is about $328,” said Hedley, referring to those CPMs who accept Medicaid. Currently, Maryland Medicaid does not cover home birth services.

Having a home birth is considered an out-of-pocket expense and is not always reimbursed by insurance. Kopf charges $3,900 per birth.

Birthing centers provide alternative for expecting moms

For expectant moms who don’t want to deliver their babies in a hospital, birthing center are another option. Shaina French, is a certified nurse midwife with Anne Arundel Medical Group Bay Area Midwifery, a freestanding birth center located on the main hospital campus of Anne Arundel Medical Center...

‘Challenging’ and ‘euphoric’

With more than 600 births under her belt in her solo practice, Kopf also trains other women to become midwives. One of her novices, Tova Brody, 27, used Kopf as a midwife for all four of her pregnancies. Brody said she had always been interested in natural childbirth and got involved in the activism side of midwifery working with the organization Maryland Families For Safe Births, after the birth of her first daughter. But it was the birth of her fourth child, Shifra Brody on June 7, and her experience with Kopf that prompted her to enter the field.

Recently, while her infant daughter slept in her arms, Brody explained her path to becoming a midwife. “It was like meeting a grandmother,” she said about Kopf. “She was someone wise and loving; she had complete trust in the birthing process. I knew this was something I wanted to be a part of. It empowers women,” Brody said.

Fletcher and Lexi Cunif, who live in Catonsville, expected they would have their first child in a hospital. But although Lexi, 27, is a nurse, she wasn’t sure the hospital experience was for her. Fletcher, 40, said he and his younger brother had both been born at home, and their younger sister was born at a birthing center. After an initial appointment with Kopf, the Cunifs decided to forgo the hospital birth and have their baby at home.

To prepare themselves for the upcoming birth, the couple attended private birthing classes in Pikesville with a doula — someone who specializes in birth coaching — whose specialty is in hypno-birthing, a philosophical approach to childbirth that teaches relaxation, special breathing and meditation during the birthing process. They also hired the same doula to assist in Lexi’s labor.

“My wife was 52 hours in labor. There’s only so much preparation you can have beforehand,” he said of the experience. He said he was grateful that the doula was on hand to help coach him and to give undivided attention to his wife.

“It was a surreal, extended sleepover,” he said laughing. “There were five of us crammed into the bedroom.”

When their baby daughter, Brynn, finally made her appearance, Fletcher said it was a euphoric moment for him.

“As challenging as it was, we were really happy to have done this at home—I can’t thank them enough,” he said of Kopf, Brody, and their doula.

‘Peaceful feeling at home’

Kopf said she has had clients who previously had hospital births they weren’t happy with. They said they didn’t want all the medical intervention and didn’t like not being able to make decisions themselves.

“They want the feeling they are involved and want that peaceful feeling at home,” Kopf said.

Kopf said she likes to spend a lot of time with her clients, and usually only takes on three to five clients per month. She said she does get a different range of people in different stages of their pregnancy, but most new clients are between 10 and 12 weeks into their pregnancy.

The time she spends with them also includes post-delivery, where she stays with the mother and newborn for a few hours after birth. She follows up again 24-48 hours afterward, then sees them again up through six weeks.

“Taking too many clients means I wouldn’t get to spend a lot of time with them,” Kopf said.

Kopf said clients decide what style of birth they want. Some may prefer their bed, but using a tub, which Kopf provides, seems to be a popular choice.

“They call the tub ‘nature’s epidural’; it feels weightless and lessens labor pains,” she said.

Kopf and Brody don’t whitewash the fact that having a baby naturally will hurt, but they believe that being at home and allowing nature to take over is a beautiful and natural experience.

“If labor is uninterrupted, it increases the intensity that the body can handle,” Brody said. “The pain is never bigger than you because it is you; women can trust their bodies.”

Midwives, including Kopf, also work with masseuses, acupuncturists, chiropractors and doulas to help their clients through the birth process.

“We do encourage them to hire a doula,” she said. “We also encourage them to eat and drink while in labor.”

Kopf said there are no typical scenarios with a home birth; some are short labors and some can be long. She’s attended births that took less than one hour and recently attended a birth that took four days.

“She was a trooper,” Kopf said.

Both she and Brody said that each birth is moving.

“I still cry,” Kopf said.


What is a midwife? How people become midwives, and how to choose one | killexams.com real questions and Pass4sure dumps

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Nov. 2, 2018 / 4:52 PM GMT/ Source: TODAY

By Meghan Holohan

As a student at Brown University in Providence, Rhode Island, in the 1980s, Afua Hassan dreamed of becoming an obstetrician. But her career took a sudden turn after an unexpected meeting.

“I had been seen in a clinic one day by a midwife and I said, ‘I want to be a midwife,’” the Houston-based midwife told TODAY. After graduating with a degree in African American studies, Hassan pursued midwifery and has been practicing for 35 years.

Hassan is a direct entry midwife, also know as a certified professional midwife (CPM). CPMs are not recognized in all 50 states, but Texas is one of 31 states that recognizes them, according to the American College of Nurse Midwives (ACNM). A CPM is an independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives.

Hassan attended the Houston School of Midwifery for three years, which included shadowing and assisting a midwife. For 10 years, she assisted others before finally starting her own practice in Houston.

In 2011, Hassan founded the Birthing Place, a women's health center offering well woman care, fertility consultations, prenatal, birth and postnatal services. While women can deliver at the Birthing Place, Hassan also offers home births with experienced midwives from her practice.

CPMs are one of three different kinds of midwives. The training they have, where they can practice and what services they offer varies. But most people don’t understand the difference. To them, a midwife is a midwife.

“When women are making decisions about seeking midwifery care, they don’t ask the questions about what type of midwife you are, what are your credentials and how have you been certified,” said Erin McMahon, faculty practice director and assistant professor of nurse-midwifery and women’s health at Yale University School of Nursing. “All women should be curious and ask questions about a midwife’s training and their level of experience.”

Direct entry midwife or certified professional midwife

Direct entry or certified professional midwives (CPMs) are a more community-based approach to midwifery, where people attend some classes, but learn by shadowing and apprenticing with other midwives. Most CPMs focus exclusively on prenatal and postnatal care. Hassan learned midwifery this way.

“It is like an apprenticeship model. A student would work with another midwife often in the home and sometimes in a birth center. They develop their skills with education and by working with their preceptors,” McMahon explained.

CPMs are more likely to attend home births and often do not have privileges in hospitals. While they can't prescribe medication, they frequently work closely with physicians. That's how Hassan obtains pregnancy-related medication, such as Pitocin (used to induce labor), for her patients.

While she's often allowed to stay and help the mom if she's transferred to the hospital, attending a hospital birth can feel isolating. Not all doctors welcome her or other CPMs. But she advocates for her patients even if she can’t continue helping with delivery.

“I am no longer their healthcare provider, but I am giving all the information the doctors want and I stay until the baby comes,” Hassan said.

Certified nurse midwife

A certified nurse midwife (CNM) has a bachelor's degree in nursing and master’s degree in nursing midwifery. CNMs can practice in all 50 states and they can prescribe medicine, according to ACNM. While CNMs deliver babies, they also provide care to women throughout their lives.

“We are lifetime healthcare providers. We provide contraception, gynecological services,” Shadman Habibi, director of the nurse-midwives program at UCLA Medical Center, Santa Monica, told TODAY. "We can administer routine care."

CNMs most often practice in hospitals or birth centers, though some participate in the 1 percent of home births that take place in the United States.

“The majority of births in the U.S. are in hospitals and that is where you will find the majority of CNMs,” said McMahon.

Certified midwife

A certified midwife (CM) has a graduate degree in midwifery from a program certified by the Accreditation Commission of Midwifery Education, but does not have a bachelor's degree in nursing.

Like CMNs, CMs practice in hospitals and birth centers but can only prescribe medication in certain states. Normally, CMs have close relationships with physicians who can prescribe drugs needed for their patients.

The ACNM includes CMNs and CMs in its ranks. The American College of Obstetricians and Gynecologists (ACOG) works closely with CMNs and CMs. According to a policy statement, ACOG and ACNM recognize the importance of collaboration:

“Shortages and maldistribution of maternity care clinicians cause serious public health concerns for women, children, and families … ACOG and ACNM recommend increasing the number of OB-GYNs and CNMs/CMs, utilizing inter-professional education to promote collaboration and team-based care."

Emergency care across settings

The overwhelming majority of births in the U.S., 99 percent, occur within hospitals or birth centers. Birth centers can be affiliated with hospitals or universities or they can be community-based, like Hassan’s center.

The Commission for the Accreditation of Birth Centers provides accreditation for birth centers that adhere to their standards. Regulations on setting up a birth center vary from state to state and some states make it cost prohibitive to open a birth center, Hassan said.

While birth is normally uneventful, emergencies can occur in any setting. Hospitals use standardized practices to handle emergencies.

“We have protocols in California,” Habibi, who works at the UCLA Medical Center, said. “Everyone knows the steps. We talk about it. We have drills for obstetric emergencies.”

Birth centers and CPMs also have plans for emergencies or transfers to a hospital. Hassan has a 7 percent transfer rate and she knows exactly what to do if a mom needs to go to the hospital.

“I am five minutes away from the largest medical center,” she said. “Either we get in the car or we can take the ambulance depending on the situation. I have the patient’s records. I explain what is going on.”


Midwives Are Growing in Popularity. Here’s What You Need to Know. | killexams.com real questions and Pass4sure dumps

Midwives are growing in popularity but still largely misunderstood. This three-part series aims to help you answer the question: What’s a midwife and is one right for me?

Americans are more familiar with the vital work of nurse midwives than ever before, thanks in part to the PBS show “Call the Midwife.” Yet in the United States, midwifery is often seen as a fringe choice — something strange, or even perceived as “less than” when compared with OB-GYN care.

But in a country dealing with a maternal health crisis, that may all be about to change.

An increasing number of U.S. families are turning to midwives for their maternity care despite systemic, social, and cultural barriers.

“The midwifery model of care emphasizes normalcy and wellness. It empowers women and gives them greater ownership of their health, their pregnancy, and the outcomes of that pregnancy based on choices that they’re able to make,” explains Dr. Timothy J. Fisher, OB-GYN residency program director at Dartmouth Hitchcock Medical Center and assistant professor of obstetrics at the Geisel School of Medicine at Dartmouth University.

“Unfortunately, the medical model of prenatal care can take some of that ownership away, in a way that can ultimately be detrimental for some people,” he says.

What’s the midwifery model? Midwifery care involves a trusting relationship between the provider and pregnant person, who share decision-making. Midwives also see pregnancy and labor as normal life processes rather than a condition to be managed.

Millennials in particular may want something different than the medical model when they decide to have a baby.

Saraswathi Vedam, FACNM, a midwife for 35 years, midwifery researcher, and professor at the University of British Columbia, tells Healthline, “We have a generation of consumers now who are socialized that they should have a voice in making decisions about their own healthcare. In previous generations it was more normative to [give] control about healthcare decisions to the provider.”

“Another increase [in midwifery services] is in people who’ve had negative experiences in birth — or have been with family or a friend and witnessed something that scared them — and they don’t want the loss of bodily autonomy,” says Colleen Donovan-Batson, CNM, the director of the Midwives Alliance of North America Division of Health Policy and Advocacy.

Kendra Smith, an editor in San Francisco, was determined to have a nurse midwife as her care provider for her first pregnancy. Smith drove an hour and a half for every prenatal appointment so she could access her midwifery practice.

“I understood that midwives seemed to focus more on care for the whole woman during pregnancy, and felt that there was less likelihood of complications if I had a midwife,” she tells Healthline. “I thought it would be more likely that I’d be given the time to labor naturally, even in the hospital, if midwives and nurses were supporting me.”

That’s the level of assistance the midwifery model of care strives for. Midwives see pregnancy and labor as normal life processes rather than conditions fixed solely by medical professionals.

That doesn’t mean everyone who uses a midwife has to have a low-intervention birth or go without pain medications. The majority of midwives in the United States practice in hospital settings, accessible to a full range of medications and other options.

The 4 types of midwives, at a glance Certified nurse midwives (CNM)

Certified nurse midwives or nurse midwives, have completed both nursing school and an additional graduate degree in midwifery. They’re qualified to work in all birth settings, including hospitals, homes, and birth centers. They can also write prescriptions in all 50 states. CNMs can also provide other primary and reproductive healthcare.

Certified midwives (CM)

Certified midwives have the same graduate-level training and education as certified nurse midwives, except they have a background in a health field other than nursing. They take the same exam as nurse midwives through the American College of Nurse Midwives. CMs are currently only licensed to practice in Delaware, Missouri, New Jersey, New York, Maine, and Rhode Island.

Certified professional midwives (CPM)

Certified professional midwives work exclusively in settings outside of hospitals, such as homes and birth centers. These midwives have completed coursework, an apprenticeship, and a national certifying exam. CPMs are licensed to practice in 33 states, though many of them work in states where they’re not recognized.

Traditional/unlicensed midwives

These midwives have chosen not to pursue licensure as a midwife in the United States, but who still serve birthing families in home settings. Their training and background varies. Often, traditional/unlicensed midwives serve specific communities, such as indigenous communities or religious populations like the Amish.

Share on Pinterest Benefits of midwives

In areas like the UK and the Netherlands, midwives are the standard providers of care for pregnancy and birth, attending over two-thirds of births. While shows like “Call the Midwife” and documentaries like “The Business of Being Born” have led some Americans to choose midwives as their care providers, they’re still vastly underutilized.

Currently, CNMs attend only about 8 percent of births in the United States. The majority of those are in hospital settings. Out-of-hospital births account for about 1.5 percent of all births. About 92 percent of these are attended by CPMs.

Midwifery care is safe — some say safer than physician care — for women and families at lower risk. People who use midwives report high levels of satisfaction with their care.

A 2018 research analysis found that, in hospital settings, people who have midwives are less likely to have cesarean deliveries, commonly known as C-sections, or episiotomies. Other research has found that people who birth with nurse midwives are more likely to breastfeed and less likely to experience a perineal laceration during birth.

Vedam and Fisher were authors on a recent study that examined all 50 states in terms of integration of midwives — including CNMs, CPMs, and CMs — into the healthcare system.

The study found that states with higher integration, such as Washington, had better outcomes for both mothers and babies. This equated to more natural births, less obstetric interventions, and fewer adverse neonatal outcomes than states with lower integration, such as Alabama and Mississippi.

5 things to know about midwives
  • Only 8 percent of births in the United States are attended by midwives. In the UK and other countries, they attend over two-thirds of births.
  • Research shows that people who use midwives often lead to better outcomes for mothers and babies.
  • Midwives treat women without children too. Over half of midwives say that reproductive care is one of their main responsibilities.
  • There are four kinds of midwives that range in schooling and certifications.
  • The majority of midwives practice in hospital settings.
  • Barriers to midwifery care

    Midwifery care is often difficult to access, even for those who want it.

    Midwives aren’t as readily available or accepted as part of the obstetric culture in some areas and regions. For example, there are currently only about 16 CNMs and 12 CPMs licensed to practice in the entire state of Alabama.

    State-by-state regulation also limits midwifery practice for both CNMs and CPMs. This can make it more difficult for midwives to do their jobs and for consumers to understand midwives’ roles and choose them as providers.

    For people who want to use midwives out of the hospital, barriers can be even greater. Some insurance, including Medicaid, won’t cover out-of-hospital birthing options, including birth centers. These out-of-pocket costs aren’t feasible for many families.

    Midwives and women of color

    Cultural competency, too, is an issue. A profound lack of midwives of color makes it even less likely that women of color will access midwifery care.

    Currently, black women in the United States are three to four times more likely to die in the perinatal period than white women and, according to the March of Dimes, are 49 percent more likely to give birth prematurely.

    This disparity may be because providers may underestimate the pain of black patients or dismiss their symptoms. Serena Williams is one example. She had to demand her doctors check for blood clots after the cesarean delivery of her daughter in 2017.

    Midwifery care could make a difference in birth experiences for black women. Yet it can be next to impossible for black women to find midwifery providers who look like them.

    Racha Tahani Lawler, a black CPM who’s been practicing for 16 years, estimates that there are less than 100 black CPMs in the entire country. As of 2009, 95.2 percent of CNMs identified as Caucasian.

    Many of Lawler’s clients aren’t aware of midwifery or home birth options, she says, until they have a bad experience. “The catalyst for most black people is ‘I don’t like the way they’re treating me,’ or ‘I feel like I am being harmed in my appointments,’” she says.

    Share on Pinterest

    Veronica Gipson, a mother in Los Angeles, chose home birth with Lawler after three birth experiences at hospitals that she felt were disappointing, disrespectful, and racialized. Although she came to Lawler with just about a month left in her fourth pregnancy, Lawler worked with her to establish care and a payment plan.

    Gipson says it was more than worth it, although she was at first intimidated by the cost of home birth midwifery: “It’s so helpful to have someone who looks like you and understands you. It’s a priceless feeling, a bond and relationship. I’m not just room 31 in the hospital — I’m Veronica when I’m with Racha.” Gipson has since had Lawler attend the birth of her fifth child.

    The future of midwifery in the United States

    Maternal health experts say midwifery could be a viable option to help solve a number of ills in the American maternal healthcare system, including:

    Still, there’s a long way to go before midwives are fully and successfully integrated into the U.S. healthcare system.

    Vedam believes it’ll take systems-level collaboration before midwifery is both accepted and integrated: “Healthcare administrators, health policy makers, researchers, providers, the public — everyone will need to work together.”

    But consumers with resources or access to healthcare coverage can still vote by seeking midwifery care and making it known that they want midwives in their communities, adds Vedam.

    Donovan-Batson of the Midwives Alliance of North America feels that when people better understand the true benefits of midwifery care, they’ll be requesting it.

    “Research shows us that midwife care is the safest care for a low-risk woman. We’re the experts in normal pregnancy and birth. So, if you want to have that normal experience, seek out a midwife who will work with you to get you the care that you desire.”

    And if that day of full acceptance ever comes, there’s a good chance American mothers and babies may be in better care.

    Want to read about how midwives treat women without babies? Or our profile of a badass midwife making vaginal breech births a thing again? Watch for both stories later this week.

    Carrie Murphy is a freelance health and wellness writer and certified birth doula in Albuquerque, New Mexico. Her work has appeared in or on Elle, Women’s Health, Glamour, Parents, and other outlets.


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