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 . 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 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.”
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