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Tuesday, May 29, 2012

A Brief Summary of The Differences Between a CNM, CPM, Doula, and Monitrice

The world of birth professionals can be confusing, especially to first time parents. I’d like to focus on just these four for the purposes of this post: certified nurse midwife, certified professional midwife, doula, and monitrice. There are also lay midwives (also called direct entry midwives) and certified midwives, but for now we will just focus on the aforementioned group.

Note: though there are male CNMs, CPMs, doulas, and monitrices, they are decidedly less common, so for purposes of this post, we’ll use ‘she’ as a generalization.

Certified Nurse Midwife (CNM)

A CNM has first trained as a registered nurse and then gone on to two more years of nurse-midwifery schooling. CNMs generally practice in hospitals only and are often not trained in homebirths, though they do sometimes practice in birthing centers. Obviously with RN training and hospital work under her belt, she has a much more medically-leaning mind and practice. It is important to understand that some CNMs practice under a physician and are bound by physician and hospital policies and procedures. Check with her to find out if she that is the case with her. She’s the one you go to when you want or need a hospital birth, but with a kinder, gentler, more personal and mama-centered touch. CNMs can also typically offer more full scope well-woman care.

Certified Professional Midwife (CPM)

According to The North American Registry of Midwives, “A Certified Professional Midwife (CPM) is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the Midwives Model of Care. The CPM is the only midwifery credential that requires knowledge about and experience in out-of-hospital settings.” She is qualified to care for you and your unborn babe all through your normal pregnancy, can help you safely birth your babe at home or at a birth center, and cares for you and babe during the first six weeks postpartum. She is your go-to woman when you want the comfort of your own home, your own decisions, your own birth experience.


The word doula is Greek loosely meaning “woman helping woman.” As with all these birthing professionals, she is a God-send (or Goddess-send, or whatever-is-holy-to-you-send…don’t make me keep going). She is your emotional and practical support either for birth or postpartum, as those are the two main types. She also helps you advocate for yourself if you have chosen to go to the hospital (or are transferred there due to circumstances). She is like the best, most perfect, soothing, understanding, supportive mom you could ever wish for (no offense to your mama). And a postpartum doula will be all that for you while helping with the more mundane, but often overwhelming immediately after having a babe, tasks around the house and in your life.

"If a doula were a drug, it would be unethical not to use it." ~John H. Kennell, MD. cofounder, DONA


This is probably the least common and least understood of the birth professionals. Some people use the term monitrice and doula interchangeably, but there are differences, slight though they may be. A monitrice is quite like a doula, but with a smidge more training. She is quite like a midwife, but with a less training – she is frequently a student midwife. She the Baby Bear chair of the birth professional world – “just right” and just between midwife and doula. A monitrice has had doula training plus usually nursing or midwifery training. She is labor coach, advocate, and support system all wrapped up in one wonderful body. With a monitrice, you can stay home longer, if you’ve chosen to have a hospital birth, because she has clinical skills such as fetal heart rate monitoring, maternal blood pressure monitoring, vaginal exams, if you choose to have them. She will generally be on-call during your pregnancy and provide prenatal, labor & delivery, and postpartum services. She’s not as common as a doula, but certainly worth looking into as long as you’re interviewing support professionals anyway.

None of these are meant to take the place of a loving, supportive partner, but to add to the support system a mom already has in place. Everyone there should have a job. Nobody should be there just to gawk, relax, and reap the rewards of your hard work. Customize your support team to your needs and let them do just that – support you and yours.

If money is a concern for you (and isn’t it for most of us?), you might want to consider getting a student doula or monitrice, as their rates are generally much less and even, sometimes, free. They’re every bit as amazing and, as a two-fer, they’re cheap…score! Really, though, all of these birthing professionals are priceless. The monetary cost is nothing in comparison to what they provide for you, your partner, and your babe body, mind, heart, and soul.

What did we choose? Well, we found the most amazing CPM who was once a CNM and before that had been an L&D RN for several years. She had with her a student midwife who was also a doula. We could NOT have been any more blessed. We go the homebirth midwife with the training of the nurse-midwife and the doula came for free with the deal! Whenever I speak or write of them (or to them, because we are still in touch on a personal level…can’t say that about an OB), I tear up. They are two of the most amazing women I have ever had the pleasure of knowing and I know that they are two of the reasons we have the miracle son we have. I can’t go on…my eyes are all blurry for some reason…….

*My eternal thanks goes to Allyson Juneau-Butler of Well-Rounded Momma and April Kermani of both Baby’s 1st Day and Well-Rounded Momma. Without their help, I would have nothing to write about. And without Allyson’s help, I would’ve made all sorts of doofy mistakes in this post!

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