Katherine S Puls, CNM

About Kathy What is a CNM? What does a CNM do? Why choose a CNM? The Practice The Office

Why choose a Nurse Midwife?

Quality of Care

"The quality of CNM care is equivalent to physicians' care within their area of competence, according to a 1986 study by the Office of Technology Assessment. Further, they are better than physicians at providing services which depend on communication with patients and preventive action."

The Medical University of South Carolina Twin Clinic study demonstrated a lower rate of very early pre-term births, very low birth weight infants, neonatal intensive care admissions, and perinatal mortality in a CNM directed clinic where CNM care is given when compared to a MD directed team where MD care is given. This demonstrated that the contribution of CNMs to high-risk prenatal care can be considerable.

The State Advisory Committee to Florida's Healthy Start Program recommends that Florida work toward the goal of having 50% of normal pregnancies be cared for by midwives by the year 2000. This is part of the State of Florida's plan to decrease infant mortality and the rate of low birth weight infants. Other states have implemented similar plans.


A study at two Kaiser Permanente Medical Centers in California showed a 13% or $292,000 reduction in payroll costs at one center and a 7% or $2 million reduction at another center when CNMs were added to the obstetric team.

If only 50% of 4,060,000 births were attended in freestanding birth centers, not only would access to care be greatly improved, but savings would be almost $4 billion annually.If only 50% of 4,060,000 births were attended in freestanding birth centers, not only would access to care be greatly improved, but savings would be almost $4 billion annually.

How is a Nurse Midwife different than a Physician?

Nurse midwives consistently spend more time with their patients both at office visits, whether for prenatal or gynecological care, and during labor and birth. An important part of nurse midwifery care is taking the time to find out a patient’s concerns, offering support, and doing patient and family education.

Utilizing a birth plan and identifying alternative resources for coping with pregnancy, labor, birth, breastfeeding, parenting, gynecological problems, and menopause are part of a nurse midwifery approach to care.

Gynecological Care

Nurse Midwives focus on educating the woman and her family — whether it is dealing with the physical and emotional changes associated with pregnancy, coping with labor, birth and the newborn, deciding on a method of contraception, or coping with gynecological or menopausal concerns. Patient education materials (both commercial and those developed by an individual nurse midwife) are vital to a nurse midwife’s practice.

Nurse midwives are prepared to care for normal woman during their lifetime. However, it is difficult to predict who is going to be normal. Therefore, nurse midwives work with physicians when their patients need care that falls outside of nurse midwifery parameters of practice.

Professional relationships often move into the personal realm and develop into lasting friendships. One of the biggest joys for a nurse midwife is the holiday cards and photographs from the families she has impacted.