Tag Archives: midwives

Home Birth: What you need to know

Home Birth: What you need to know

Monica Basile, PhD, CPM, LMT

Home birth is a safe and reasonable alternative to hospital birth. For many families, home birth provides optimal conditions for achieving physiologic birth in a familiar and intimate setting, with personalized and expert care.

How common is home birth?

The CDC reported in 2012 that home birth is on the rise nationally.[1] While less than 1 percent of all births in the United States take place outside the hospital, the number of these births increased by 3.5 percent between 2003 and 2006. The CDC reports that Iowa’s rate of home birth is significantly higher than the national average. Approximately 500 women give birth at home every year in Iowa.

Why do people choose home birth?

Photograph submitted by the family.

Photograph submitted by the family.

People choose home birth for a variety of reasons based on physical, emotional, cultural, and spiritual factors. Those who decide to birth at home span socioeconomic classes and they come from every demographic,  profession, and religious and political affiliation. A 2009 study in the Journal of Midwifery and Women’s Health reported on the motivations people cite for choosing home birth.[2] The most common were:

 

  • Increased safety (24%)
  • Avoiding unnecessary interventions (24%)
  • Previous negative hospital experience (23%)
  • More control and autonomy (22%)
  • Comfortable, familiar environment (19%)
  • Trust in the birth process (16%)

 Is home birth safe?

Many peer reviewed, scientific studies have found that for healthy women who experience normal pregnancies, a planned, midwife-attended home birth is just as safe as hospital birth, with far lower rates of medical interventions.[3] While the nationwide cesarean rate is over 30 percent, the rate of transfer for a cesarean during a planned home birth is only 3.8 percent. The safety of home birth has been affirmed by public health organizations such as the World Health Organization and the American Public Health Association.[4]

 What type of care do home birth midwives provide?

Home-birth midwives specialize in providing primary health care in out-of-hospital settings, and in supporting women to maintain a healthy pregnancy and birth. They provide comprehensive prenatal, birth, and postpartum care to low-risk women. Home-birth midwives can also recognize deviations from the norm and they will refer care to other healthcare providers when appropriate. There are several types of midwives who attend home births: Certified Nurse Midwives (CNMs), Certified Professional Midwives (CPMs), and Traditional Midwives.

The average length of a prenatal visit with a physician is 10 minutes, whereas the average length of a prenatal visit with a home-birth midwife is about an hour. Home-birth midwives value respectful treatment, personal attention, informed decision-making, appropriate monitoring and risk assessment, instilling confidence in a woman’s body, natural techniques for comfort in labor, family-oriented care, and parent-child bonding. Six weeks after a home birth, more than 90 percent of mothers are breastfeeding successfully.[5] The midwifery model of care is holistically oriented, seeking to enhance the physical, psychological, and social well-being of the mother throughout the childbearing cycle. Midwives also offer excellent continuity of care.

What about complications?

Photograph by Laura Eckert, A New Creation Photography

Midwives screen clients carefully and care for only healthy, low-risk women. Midwives are trained in emergency skills such as neonatal resuscitation, and in facilitating a safe transfer of care, if needed. The vast majority of transfers during labor, from home to a hospital setting, are non-emergent.

 

 

Is home birth for everyone?

No. Home birth is contraindicated for women who have risk factors for certain health conditions, or for those who develop complications arising during pregnancy. Also, it is not for women who have a personal preference for birthing in the hospital.

References:

[1] MF MacDorman, TJ Mathews, E Declercq. “Home births in the United States, 1990–2009.” NCHS data brief, no 84. Hyattsville, MD: National Center for Health Statistics. 2012.

[2] Debora Boucher, CNM; Catherine Bennett, RNC, BSN; Barbara McFarlin, CNM, PhD, RDMS; Rixa Freeze, PhD, MA “Staying Home to Give Birth: Why Women in the United States Choose Home Birth” JMWH, Vol. 54, No. 2 (March/April 2009), p. 119.

[3] Kenneth C Johnson and Betty-Anne Daviss, “Outcomes of planned home births with certified professional midwives: large prospective study in North America.” BMJ 2005; 330:1416 (18 June); S Vedam, K Stoll, L Schummers, C Fulton, “Home Birth: An Annotated Guide to the Literature, 2013.

[4] American Public Health Association, “Increasing Access to Out-of-Hospital Maternity Care Services through State-Regulated and Nationally-Certified Direct-Entry Midwives (Policy Statement)”. American Journal of Public Health, Vol 92, No. 3, March 2002; Maternal and Newborn Health/Safe Motherhood Unit of the World Health Organization, “Care in Normal Birth: A practical guide.” World Health Organization, 1996.

[5] Kenneth C Johnson and Betty-Anne Daviss, “Outcomes of planned home births with certified professional midwives: large prospective study in North America.” BMJ 2005; 330:1416 (18 June);

Midwives

I want to share some thoughts with you on midwifery legislation in our state.  Midwives are consistently supported by evidence to be the best providers for normal birth.  When I say this it does not mean that other providers are bad—quite the opposite.  Other providers have a place and are a very necessary piece of the modern birth puzzle.  Supporting midwives is not an effort to eliminate other providers.  

I believe that birth is a normal physiological function of a woman’s body.  I do not believe that pregnancy and birth are pathogenic (e.g. disease or illness).  Therefore, I do not believe that birth requires the practice of medicine.   Under this assumption I do not believe that midwifery is the practice of medicine.  Midwives support normal birth and I love them for it!  That being said, I also believe that we live in a society that largely does not agree with this, despite significant evidence to the contrary.

So what should we do when it comes to legislation?  Do I wish we could declare the practice of midwifery “not medicine” and decriminalize it?  Ultimately, yes.  That would give power to the consumer to make informed and educated decisions about their care provider(s).  However, where we stand currently there are no legislators in our state willing to support that.  That’s where we stand.  This leads me to lend my support to the licensing of Certified Professional Midwives (CPMs).

A little history lesson to elaborate on my stance:  One of the HUGE reasons we are in this “midwife mess” in the first place is because in the late 18th century men, with their new medical degrees out of Europe, started to attend births.  They called themselves man-midwives, because what else would you call a birth attendant!  The man-midwives (doctors) wanted to build their businesses, and one of the ways to do this, as we know all too well, is to eliminate the competition.  In this case, that meant eliminating midwives.  This was largely done through propaganda campaigns against midwives.  WE ARE HAVING THIS CONVERSATION TODAY BECAUSE THESE CAMPAIGNS WERE SO SUCCESSFUL!   One of the reasons the campaign against midwives is said to have been so successful is because the doctors grouped together.  They formed alliances and guilds and grew in number and power. This also improved their ability to communicate and present a unified front of the midwife “issue.”  For whatever reason, the midwives weren’t able to organize on a large scale and present a unified front.   Some writers have suggested that the midwives didn’t really see the doctors as a threat.  Perhaps they were thinking along the lines that I am, “birth is normal; therefore non-medical, and for all of history women (midwives) have attended other women in labor – we’re not worried.”  Let’s not underestimate the issue of power here.  Even in the areas where midwives did organize, at this time in history a group of women held little power when it comes to business, politics, and policymaking.

Let’s not make that mistake again. 

The history of birth in this country that tells me we need to unify around the issue and take action.  I’m unifying around the idea of increasing access to midwives.  I’ll always hold out hope that someday my education and change efforts will reach the tipping point and all will come to recognize that birth is normal.  Don’t get me wrong, I’m not giving up that fight – not at all.  Supporting midwives and the consumers who want to legal access them does not change the need to continue to educate and promote ongoing change.

Where we are right now: We are organized. We have the support on the legislative front.  And we have SCIENCE.  Yes, the evidence is also on the side of midwives. My belief is that licensing midwives in our state is a positive and necessary step for consumers of maternity care in our state and (in my opinion) for the midwives too.

One of the things that also happened in our collective birth history is that the man-midwives, who later declared themselves obstetricians, gained power over birth; previously it belonged exclusively to women. In doing so they also took it upon themselves to start naming and defining things.  The power to name and define is huge.

Imagine: for all history this thing that I am sitting on has been called a chair and has been sat on.  Then, rather suddenly, a group of people holding significant power come along and tell me that this is no longer to be called a chair and it is no longer for sitting.  If anyone wants to sit in it, there will be consequences.  If you want to use this chair properly, and without consequences, you must do so through us.  A few folks wanted to keep sitting in chairs so the group “allowed” this, but only under their regulation. 

The fact of the matter is that they have the power.  They are still able to name and define.  And until we enter into their realm and gain a seat at the power table we will continue to struggle. We have to play that game.  This legislation would mean a seat at the table, to be part of the naming and defining conversation.  It’s not ideal, but it’s better than being ignored and persecuted. It is a step in the right direction.  It is acknowledgement and recognition for midwives and their valuable role in society.  Someday I’d like to see the tables flip.  I’d love if the United States would figure out that the birth outcomes in countries where midwives are the primary birth attendant are not a fluke occurrence.  I’m going to continue to do the work I do to educate people under the belief that someday we’ll get there.  I feel confident in supporting this legislation because I believe it is a necessary means to keep moving us forward.

For more information about where midwives stand in Iowa and across the country check out The Big Push and Friends of Iowa Midwives.  

– Mandi Hardy Hillman, PhD, LPC, CD(DONA), ICCE

* When I contribute to this blog (or any blog) I always sign my name.  That means these are my thoughts.  Although, often they align with those of other IBO leaders and “fans,” they may not always.