The Terrifying Side of Trendy: Are Home Births Safe?

From the legal firm blog of Console and Hollawell cross posted with their permission

My childhood friend and her husband wanted an at-home birth. Like many, they were attracted to the idea of bringing their child into the world in a calm and peaceful setting, exchanging hospital linoleum for their cozy California home. They weren’t against technology, they were simply taken in by a growing trend that popularizes midwifery as enlightened, almost luxurious. As society emphasizes “all-natural” and “organic,” a home birth can appeal to intellectuals and progressives alike as an alternative to an allegedly intrusive, chemical-soaked hospital.

Every family has the right to experience childbirth as they so choose. The problem arises when couples are misinformed about their midwives’ training and naïve to the dangers of home births. As home birth becomes more popular, increasing by 29 percent from 2004 to 2009 reports the CDC, it’s attracting people who don’t fully understand what they’re getting into. Unaware that not all midwives adhere to standard medical licensing and regulations, families come out of home births feeling deceived – or worse.

Not All Midwives are Created Equal

There are two broad categories of midwives in the U.S., and only one is considered a medical professional.

These are certified nurse-midwives (CNMs), and they successfully graduated from a university-affiliated program accredited by the American College of Nurse-Midwives (ACNM), making it legal for them to practice in all states. As their title implies, they are registered nurses that often work in hospitals.

The second category is a direct-entry midwife, which encompasses a range of practitioners whose legality differs state-by-state. They are not required to be nurses, may or may not have a college degree, and may or may not be certified by a state or national organization, according to Citizens for Midwifery. To put this in perspective, someone can’t professionally shampoo hair in the state of New Jersey until they’ve had 600 hours of formal schooling from an institution approved by the State Board of Education, according to the Division of Consumer Affairs. And that’s only halfway to the 1,200 hours required for a full cosmetology-hairstyling license. On the other hand, essentially anyone may call herself a direct-entry midwife with no implication as to her skills, education, or legal right to practice.

Most home births are attended by this second kind of midwife, including my friend’s.

The Growing Homebirth Trend: Stylish or Unsafe?

So what exactly is enticing people into home births with midwives that may or may not know more about the miracle of life than what they learned on the Discovery Channel?

Apparently, it’s becoming quite chic. “Are midwives becoming trendy, like juice cleanses and Tom’s shoes?” asked The New York Times. “It seems that way, at least among certain well-dressed pockets of New York society, where midwifery is no longer seen as a weird, fringe practice favored by crunchy types, but as an enlightened, more natural choice for the famous and fashionable.” It’s become a sort of status-symbol. Supermodels like Gisele Bundchen had their babies delivered by midwives, so it must be the socially up-and-up thing to do.

However, as with many celebrity actions the public tries to replicate, the results are far from equivalent. A supermodel’s experience is not necessarily going to be had by Jane next door. They get a nose job from the most prestigious plastic surgeon in the country, and some poor soul finds an advertisement that leads them to a seedy garage. While this may be an exaggeration, it demonstrates the important point that the public perception of midwifery is dangerously informed by magazines and the media. Take the 2007 film The Business of Being Born, for example. It has done an enormous amount to popularize contemporary midwifery, but the message of the movie relies more on emotional appeals than substantial scientific evidence, says Sciencebasedmedicine.org.

While celebrities are pulling elite strings to have their babies in boutique midwifery clinics, many people hear “midwife” and automatically assume having a baby at home. This is not always the case. What many celebrities get is not a true home birth at all, but simply one attended by a midwife at a hospital or alternative facility. Many CNMs won’t even deliver babies at home because the liability insurance is so expensive, up to $25,000 a year, or doesn’t cover it at all, says Nurse.com. That’s why the majority of caregivers that perform home births are direct-entry midwives, reports the CDC. In 2009, 43 percent of home births were attended by direct-entry midwives, while only 19 percent by CNMs. How many mothers realize that direct-entry midwives are not carrying around the licenses and medical education they assume them to have? Without it, midwives may not recognize maternal and fetal distress signs or know how to treat them.

While women may choose house over hospital for a variety of reasons beyond chicness, including financial (home births cost about one-third as much as hospital births), cultural, or religious concerns, misconceptions run rampant. As long as these false impressions exist, innocent women and children are put at unnecessary risk.

Home Births Are Three Times More Dangerous

Many home birth champions praise them as divine, even orgasmic, experiences. While this may be true, so is the growing number of tragedies.

My friend’s labor began well. The midwife was there, coaching her through it. But a normal delivery can turn into disaster in a heartbeat. When they ran into complications, the midwife said it was normal. Her husband disregarded the midwife and, utterly concerned for the lives of his wife and child, called an ambulance. When the ambulance arrived, the midwife had shooed it away before my friends could even get out the door.

The idea of having the hospital as a failsafe, a Plan B., relaxes many parents. Should something go wrong, they figure they can just hop in the car. Hospitals often receive home birth transfers, says the Daily Beast, and many an OB “has treated a woman rushed in with a dead or severely injured baby.” So while my friends incident may be a rare one, the midwife literally removing the hospital option, it is not rare for home births to go awry and midwives to lack the knowledge or tools to remedy the situation. “Patients who appeared to be low-risk candidates and would seem well-suited to home birth, wind up with serious, unexpected problems,” further reports Nurse.com.

The American College of Obstetricians and Gynecologists (ACOG) says that home birth is  two to three times more dangerous than hospital birth, and the hazards inherent to labor require standards of safety only a hospital setting can provide. In a report detailed by Aetna, the five-year period from 2000 to 2004 saw 1,237,129 hospital CNM attended births and 42,375 home “other” midwife attended births. The newborn mortality rate per 1,000 live births for the former was 0.5, while the mortality rate for the latter more than doubled to 1.8. However, this is just one study, and it doesn’t speak to the maternal fatalities at all. How many more mothers, and babies, are being harmed, whether fatally or suffering from conditions such as preventable brain damage?

Let’s Have Babies Like Its 1911

The lack of medical intrusion is precisely what many mothers are looking for. Many view it as more calming and healthier for the child. They proclaim that people had babies at home for hundreds of years. While this may be true, the birth fatality rate also used to be incredibly high, 135 deaths per 1000 live births in 1911. Doesn’t there seem to be a correlation between advances in medicine and decreasing infant fatalities? Does having your baby in the equivalent of 1911 sound appealing?

Ranging from epidurals to mother-newborn bonding time post labor, many parents are concerned about what they call the “cascade of interventions,” says ABC. Cesarean sections are a chief worry. Nearly a third of all births in the U.S. involve C-section, a far higher rate than in most other developed nations, says Livestrong.com. Although a C-section is a major surgical procedure, it is these very “interventions” that can keep mothers and children alive when unexpected dangers present themselves.

I’m not asserting that obstetric care in America can’t be improved. It certainly can. We are far from the best in the world in regards to infant and maternal mortality rate, but I don’t think home births are the answer. Avoiding a C-section during a home birth because midwives don’t have the fetal monitoring capacity to determine when they’re necessary is bred from irresponsibility, not safer birthing methods. Many midwives also assert that C-sections hinder mother-child bonding, yet I know countless women that have undergone C-sections and would be highly offended to hear they are less emotionally connected to their baby.

It was later discovered my friend had suffered a uterine rupture, a common occurrence if a woman has previously given birth via C-section, which she had. While vaginal birth after C-section (VBAC) has become an essential part of modern obstetrics, it is not so for midwifery. Uterine rupture is a known complication that physicians are ready to manage with surgery, and usually with good outcomes, according to the American Academy of Family Physicians. Midwives, on the other hand, have no way to perform immediate, life-saving surgery. Furthermore, the sign of a ruptured uterus is usually fetal bradycardia, an abnormally low or slow fetal heart rate. Without ultrasounds, which some midwives say cause birth defects, there is no way for them to detect these potentially catastrophic complications.

Isn’t shunning modern healthcare asking for unnecessary risks?

But My Midwife Was So Nice

What many mothers tout as outweighing the risks is the personal relationship they have with their midwife, and the sense of empowerment they feel by taking control of the birthing process. Obstetricians are less idealistic and more practical, and midwives often provide emotional support. But the truth is, birth is extremely messy and painful. Providing pain relief is one of the great tenets of modern medicine – we no longer amputate a soldier’s limb while he writhes in agony – so is toughing it out a sign of empowerment, or a sign of ignorance? Is “nice” going to save your life?

Compassion is not the same thing as capability. Home births may be a safe alternative for healthy women with a qualified provider, notes ABC, but many people who’ve had tragic home births never knew what direct-entry midwife credentials did and didn’t involve. If parents really understood the risks they were taking, would they still do it?

My friend and her baby died. I think of them all the time, and I don’t know that I will ever forgive the midwife who turned the ambulance away, so I can only imagine how tormented her husband is. Surviving parents may regret their decision every day, always questioning whether things would have turned out differently had they been in the hospital to begin with.

Many hospitals these days offer lovely birthing rooms, which you can adapt with music, aromatherapy, friends, and family – whatever makes the environment comfortable for you. Honestly, once the baby is born, most parents will be far too distracted by their bundle of joy to be annoyed by a hospital’s ambiance. As the vessel bringing new life into this world, it’s our responsibility as parents to do it safely.

The safety of birth in any setting is of the utmost priority. Looking at the basics, does it seem safer to have a range of trained professionals and medical supplies at your fingertips, or stay at home with someone presumably less qualified, and risk a last minute dash to the hospital if things go awry? The stakes are so high. While women have every right to make informed decisions about where and how to give birth, the key part of this equation is “informed.”

Comments open below

NLQ Recommended Reading …

Breaking Their Will: Shedding Light on Religious Child Maltreatment‘ by Janet Heimlich

Quivering Daughters‘ by Hillary McFarland

Quiverfull: Inside the Christian Patriarchy Movement‘ by Kathryn Joyce

 

About Suzanne Calulu
  • Simon Bransby

    Thank you for this. It truly needs to be out there, and the more people see it, the less ignorance there will be.

  • http://yllommormon.blogspot.com/ aletha

    Ignore the previous comment I made. I posted something stupid.

  • Rachel Heston-Davis

    While wanting to be respectful of the people who choose home birth, I also have to express concerns about it. I have known 4 people who attempted home birth. Two ended up in the hospital anyway, and one had an “emergency” that THANK GOD the midwife was able to handle, but it could just as easily have gone the other way. Only the fourth made it through the experience easily. While this is not any kind of reliable data, just my own personal anecdotes, I can’t help but be put off the idea when my friends have only had a 25% success rate of happy, healthy, safe home births :/

  • http://www.carpescriptura.com/ MrPopularSentiment

    I had a midwife-assisted hospital birth. Talk about the best of both worlds!

    But I live in an area where midwives are highly regulated, and where they have very good, formalized relationships with the hospitals – which makes transfers much easier, and makes midwife-assisted hospital births possible.

    There are reasons to choose homebirths, given the right conditions. I have a friend who had a very easy first birth and an uncomplicated second pregnancy. She was labouring in the spring, so there was no chance of a blizzard or other condition that could make getting to the hospital problematic. She also lives about two blocs away from the hospital. Given all of this, a midwife-assisted homebirth made perfect sense. She did fine, she was more comfortable at home, and she had a clear exit strategy if things went pear-shaped.

    So yes, a lot of people are choosing homebirths who really shouldn’t, and a lot of people are choosing them for the wrong reasons and without really understanding what the consequences could be for themselves or their babies. But the heart of the problem is lax midwife/birth assistant regulations, and a medical care system that allows anti-medicine people to play doctor when people’s lives are on the line.

  • AlisonCummins

    Was your friend being attended by a CNM who could recognize pear-shaped approaching in the distance, or a direct-entry midwife who couldn’t recognize pear-shaped if she were standing in its blood?

  • AlisonCummins

    Ok.

  • Madame

    I had three midwife-assisted hospital births. I was offered home-births because all pregnancies were low-risk and I was healthy and fit. I chose to deliver in hospital.

    Midwives in the UK have to be certified to practice and they are registered with the NHS. They work with their local hospital and local doctor surgeries. My first son was delivered by a trainee, under the supervision of a fully qualified midwife, with my consent.

    I think any person who isn’t fully qualified and is practicing medicine should have any license or certification removed immediately. You can’t drive alone with a learner’s permit. Why should you be allowed to assist births without a full qualification and experience under the supervision of a fully qualified midwife?

  • http://www.carpescriptura.com/ MrPopularSentiment

    The distinction is an American one. Here in Ontario, there’s only one kind of midwife. They have all the basic education of a certified nurse, plus an extra few years to specialise in midwifery, plus an apprenticeship. They also practice in collectives, not alone, and each collective is associated with a particular hospital.

    In other words, the midwives here are just as likely to recognize pear-shaped as any doctors/nurses you’d encounter in the hospital. The only real difference is that they can’t administer some specialized care – for example, you need an anaesthesiologist to give you an epidural (although the midwife can give you gas).

    The American medical system is broken, and the break is extra evident when it comes to pre-natal, birth, and post-natal care. The fact that you even thought to ask whether my friend was being seen by a qualified attendant when I told you that there was a certified attendant there is… terrifying.

  • Madame

    Sounds like midwifery in the UK.

    And I agree with you. It’s terrifying that certified may not mean properly trained!

  • AlisonCummins

    Well, people have friends all over the place! You didn’t specify that your friend gave birth in Ontario, you just said that midwives are well-regulated where you live.

    I’m in Québec, by the way. One of the things that happens in the US is that people pay for health care like any other consumer good. They look at the prices and wonder what they’re getting for it. If they give birth in a hospital they pay more if they deliver by c-section even if they aren’t shopping for a c-section. They pay extra for an epidural, so you get that sort of competitive bragging about not being such a wimp that they needed to pay for pain relief. (Even if they don’t pay all or even most of it themselves they see the bill.) It’s easy to feel ripped off. “I did all the work and pushing, why would I pay $20,000 so that some overpaid doctor who didn’t even know me could catch the baby?” So they shop around, and they can get more control over the experience by paying $2,000 for a boutique, in-home birth with a midwife.

    In Canada we don’t think about it the same way. We see an overall health budget being managed to get the most bang for the buck and we’re pretty sure there’s not a lot of extra money in the budget. If the doctor thinks a c-section or in-hospital delivery is the best for our overall heath she probably means it. If the hospital is handing out free epidurals we figure that epidurals are the standard of care, not that they are a profitable product for the hospital. We don’t assume the doctor is pocketing an extra $5,000 for a c-section. The culture is very different.

    In terms of “certified attendant” — that means something different in the US. The article refers to Certified Nurse Midwives who are qualified to attend births and carry insurance. There are also Certified Professional Midwives who do not have any meaningful qualification and who do not carry insurance. If you were talking about a homebirth in the US and told me that the attendant was “certified” that would tell me exactly nothing.

  • Saraquill

    I really hope that midwife was prosecuted to the fullest extent of the law.

  • Saraquill

    ON a similar note, I’m taking considerable issue with the idea that many are saying homebirth is good by virtue of it being natural. Sepsis, hemorrhaging and ecclampsia are all natural, but are things to be avoided.

  • http://www.carpescriptura.com/ MrPopularSentiment

    I agree on all points.

  • Trollface McGee

    I agree with you both. The all-natural claim is rather amusing – hemlock and spinach are equally natural. I’m all for choices especially in something as personal as childbirth but one has to make sure to take precautions (trained midwife, hospital on call, hospital birth if prenatal visits indicate any possible complication)

  • Lynn

    My local hospital has a caesarian rate of 40%. I had a five hour second stage with my first baby, and a number of doctors and nurses have assured me that I would have had a csec had I been in the hospital. I was able to birth at home attended by incredibly experienced (1000+ deliveries) midwives. One of them was Robin Lim, whom you might have seen celebrated as the CNN Hero of the Year in 2011. I really believe it comes down to choosing an experienced midwife who has a good relationship with local physicians. In the USA, the non-nurse midwife credential is the CPM, Certified Professional Midwife. They have a long list of required experiences and skills and take an all-day board exam like many other health professions. In my state, it is not legal for less-trained midwives to practice, but they still do, and they give CPMs a bad name. Decent midwives know whom to risk out and when to call for help.

  • Madame

    “it is not legal for less-trained midwives to practice, but they still do, and they give CPMs a bad name.”
    If their practice is discovered, what happens to them?

  • Lynn

    If they are a part of and exclusively serve religious communities (Mennonites and Amish) they are left alone, even when there are horrific outcomes. If others are discovered, they might receive a cease and desist order, or be prosecuted for a bad outcome. It’s pretty inconsistent, but you’re fairly safe as long as you’re discreet and skilled. For the record, I believe women should be able to choose any attendant and birth place and the law should stay out of it. Legality and standards are not consistent between states, and excellent midwives can be felons in one place and legal 5 miles away. That said, I believe in informed consent, and it’s not right for less-experienced practitioners of any service to misrepresent themselves. That’s a place for the law to step in. I had the knowledge and background to thoroughly question both my midwives about all the things that could go wrong, and frankly, both of them had better answers than my OB, who considered a csec to be the solution to everything.

  • Madame

    “For the record, I believe women should be able to choose any attendant and birth place and the law should stay out of it.”

    There are people out there having unassisted births and posting about it all over the internet. It doesn’t seem illegal, and I agree that we should have the right to decide how much medical care we want. It’s personal responsibility. But childbirth is not only about the mother and her body, it’s about the birth of another person, so I consider it reckless and irresponsible to waive proper antenatal care and the presence of a properly trained professional, especially in countries where these are widely available.

    I also believe that basic health care, like delivering a baby safely, should be covered by every insurance policy and every NHS.

    “Legality and standards are not consistent between states, and excellent
    midwives can be felons in one place and legal 5 miles away. That said, I
    believe in informed consent, and it’s not right for less-experienced
    practitioners of any service to misrepresent themselves. That’s a place
    for the law to step in.”

    This is really sad. No person who isn’t properly trained should be allowed to practice medicine anywhere.

  • back_to_my_garden

    I find it almost unbelievable that the ambulance personnel allowed the midwife to
    persuade them to leave without even looking at the patient. Are they *allowed* to do that? (My husband did nothing more than briefly faint in a restaurant and still had to argue for fifteen minutes with EMTs before they let him go home–and he was the *patient*.) Did the midwife perhaps represent herself as the patient & say “see, I’m fine”? Was she prosecuted? I hope so!

    I’m also boggling at the idea of a home-birth with a direct-entry midwife for a VBAC. The home-birth enthusiasts I know (mostly doulas) would balk at being asked to assist with something like that, and would be on tenterhooks the whole time ready to grab the phone.

    As I finished this post, I was planning a comment that was a call for balance, but given that the author had this extreme and unnecessary tragedy happen to someone he cared about, I can understand the lack of balance.

    Still, maybe I’ll say a couple of the things I had in mind. Even not being highly experienced regarding birth, there are logical problems I see in the article. It’s apparent that direct-entry midwives in the U.S. are not required to have the level of training that CNMs do (though it was always my impression that this condition mostly applied where the practice of direct-entry midwifery & home birth is illegal… but I don’t have all the facts, so I won’t insist on that.) The author states this as a fact… but then goes on to hammer home the distinction in a way that implies that all direct-entry midwives are ignorant and unskilled. This is obviously a fallacy–the truth is that the danger is in *not being able to know for sure,* as you can with a legally required certification, whether your midwife is properly trained or not. Some are very trained, skilled, and responsible; some are terribly irresponsible and operating more on notions than facts. I suppose I can see why the author might feel it is safer to say “avoid all direct-entry midwives!” but it
    would be truer to say “Don’t be overly trusting; get multiple evaluations of your midwife from people who know what they’re talking about.”

    I have no vested interest, by the way. I’m having my first child in a hospital attended by a CNM, and the only direct-entry midwife I know personally is someone I would never trust with such an important responsibility. But I do know they’re not all like that. The reason I chose the hospital I did (although it’s unfortunately 45 minutes’ drive away) is that the local hospital has a terrible reputation, both in general and in terms of unnecessary C-sections, and the only local home-birth midwife (a different person from the above) struck us as being at the other end of the spectrum–so ideological about home-birth being better that we just didn’t have a good feeling about how quickly she’d alert us to the need for a hospital birth if it occurred.

    And that to me–it being so ideological, whether in this article or in the set of pamphlets that midwife emailed us–is a symptom of the problem. It seems like in
    America we polarize everything. Homebirth can and should be a responsible practice with solid failsafes in place–in most of Europe it is, because it’s legal and adequately legally supervised. Why can’t we get it together here? Well, it doesn’t help that the two sides vilify each other. The author of this post, for instance, though not nearly as extreme as some, still seems to be preaching to the choir. If he’s trying to win over any home-birth enthusiasts, he should know it’s not going to work: he’s stigmatized them as “ignorant.” He’s used loaded mock-quotes that make them sound stupid and naive, like “let’s have babies like it’s 1911″ and “but my midwife was so nice”. He’s given a nod to the rate of C-sections in American hospitals–one-third of all births!–and dismissed this by not even mentioning that unnecessary C-sections might be a problem, but moving right on to stating that C-sections save lives… which is equally true, but clearly only part of the picture; even in the old days one-third of all women did not die for lack of a C-section. If American hospitals reduced their rate of unnecessary C-sections, maybe fewer women would feel pushed into giving birth outside of them. In any case you’re sure not going to win over home-birth proponents by implying that a one-third rate of C-sections is OK!

    I sympathize with the main thrust of this article, I really do. I’ve seen irresponsible things done and still thank God the people involved are OK. I wish people would be more informed and less ideological, I wish that people who want a natural birth were able to make safety a priority at the same time, I wish
    this whole country would revert to common sense (“Birth is a natural process and my body knows how to do it, but if something does go wrong I want the best professional help I can get.”) I wish that people would stop judging each other along what appear to have become party lines. But I would never show this article to the home-birth enthusiasts I know. It’s too likely, with its use of
    “ignorant” and its ignoring of some of their legitimate concerns, to radicalize them further.

  • back_to_my_garden

    Just wondering, since you said below that you were from Canada… do you have independent knowledge of American direct-entry midwives or are you getting this characterization of them from the article? I think the article was extreme, and also inaccurate, on this topic… the problem is a wide *variation* in their training and skills, caused by inadequate regulation–not that they’re uniformly ignorant. Some are very good, the problem is that the system doesn’t allow us a good way to recognize who is and who isn’t.

  • Nightshade

    Funny that the QF bunch cares so much about protecting life at conception, and (some) not so much at the time of birth.

  • Suzanne Harper Titkemeyer

    It boils down to midwifes should be educated and licensed. If they are not then you’re going to have a greater chance of an outcome like the one listed in the article or the many posted on the home birthing religious sites or even like Carri Chmielewski had.

    Want a home birth with a midwife then fine, But for the greater good of the community have a trained licensed midwife instead of someone as criminally inept as Judy Kay Jones or Brandi Wood, both of whom are not licensed, barely trained and have left a trail of dead babies and injured/dead mothers behind them.

  • Rachel Heston-Davis

    And while we’re talking about all-natural…one other flaw of the home-birth scenario is that it decreases your options for pain management. Some women can get through labor fine without spinals or epidurals, but I’ve known just as many who thought they would be fine but completely changed their minds and ended up going for it. How can you know ahead of time, for sure, that you won’t need it? How can you know that you won’t really end up regretting it mid-labor? I don’t think it’s advisable for a first-time laborer to just assume that she knows what she can handle in the way of labor pain.

    Some people might think that’s just a detail, but judging from a lot of women I’ve spoken to, adequate pain management really is a big deal and should not be taken lightly, for the good of the mom.

  • Hannah

    I have often thought there could easily be collaboration between this blog and the Skeptical OB due to this issue. It’s horrific and tragic.

  • AlisonCummins

    If someone is a CNM, then they are adequately trained. Someone who has all the training of a CNM practices as a CNM unless they have been stripped of their license.

    Barbara Hererra is an American doula. She used to be a homebirth midwife with homebirth midwife training until she realized that her training was inadequate. This is what she says about training:

    http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2008/3/19/midwifery-education-lite.html

    http://navelgazingmidwife.squarespace.com/navelgazing-midwife-blog/2012/7/8/reader-question-cpm-or-cnm.html

    Oh, and bonus discussion of “the hospital’s right there”:
    http://10centimeters.com/friday-fallacies-the-hospital-is-just-minutes-away/

  • AlisonCummins

    The CPM is not recognized outside the US. No other developed country considers it remotely adequate.

    Even then, homebirth with adequately-trained midwives working in collaboration with hospitals is riskier than hospital birth.

    The issue is not just training. CPMs are uninsured, which means that in the case of malpractice resulting in injury to the baby, you cannot sue for funds to help care for your child.

  • Jayn

    The thing is, on the other side you have stories of doctors and hospitals pushing epidurals or spinals when the patient DOESN’T want them. I want a low-intervention hospital birth, but I’m doing so with the worry that I may have to fight with hospital staff to get that (My OB at least has told me the minimum interventions she wants–basically CYA stuff, nothing too invasive). Just as there are mid-wives who are too ideologically focused to recognise when a transfer is appropriate, there’s also doctors who are too focused on pushing interventions, if not flat out doing things without consent. So you get people being pushed in one direction by the extremes of the other, and I’ve gotten the impression that as things currently stand in this country, it can be hard to find a solid middle ground.

  • Petticoat Philosopher

    Experience and a good record of 1000+ deliveries is certainly a good thing but it’s still not a replacement for medical training. One of the purposes of medical training is that it gives you the tools and the knowledge to handle rare situations that might crop up (in this case by turning the delivery over to people who can handle them), including situations that you have never experienced yourself–maybe even not in 1000+ deliveries. Home births go just fine until they don’t. Midwives can capably handle delivery until they can’t. If the midwife has actual medical knowledge, and not just her own experience to draw from, s/he’s a lot more likely to be able to recognize that critical point when and if it comes. There’s a first time for everything and I don’t want to the the first time with someone who’s had no formal training in how to handle first times.

  • Lynn

    At least one of those midwives had more formal training in more settings than anyone could shake a stick at! Robin worked in (and ran) clinics in several countries for decades. I emphasized experience over training, because I put more trust in a midwife with that kind of experience, than I would in one with “formal” education but far less experience. It is sad that those seem to be the only two options, but that’s politics for you. The situation is slowly changing. I’m sure CNMs are great, but at least in my state, only a very small percentage of them have physician permission to practice out of hospital birth, and no hospital anywhere near me will hire them. People can write all they want about who the best care providers are, and what is the best setting for birth, but there are wide swaths of the US where we simply do not have the options available in other places. RNs commonly graduate from the local university here without ever having seen a spontaneous vaginal birth, because they are so few and far between. We all have to weigh the risks and benefits in our given situations.

  • Lynn

    “so I consider it reckless and irresponsible to waive proper antenatal care”

    I absolutely agree with you on this one. CPMs provide prenatal care on the same schedule an OB would, and in states where they are legal and licensed, they can order all the same labs as a physician would. I don’t personally know how CNMs handle things, but my CPM provided far more thorough prenatal care than the OB I saw concurrently (and said OB didn’t know I was getting dual care from a CPM).

  • AlisonCummins

    In the US, many people believe that their midwives are licensed and trained because they have letters after their names — for instance, CPM for Certified Professional Midwife (whch sounds confusingly like CNM for Certified Nurse Midwife) or LPM for Licensed Professional Midwife. Only the CNM has adequate training. Even with a CNM or equivalent, homebirth is still riskier than hospital birth.


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