Is there a reason why most CNMs don't do homebirths?

Specialties CNM

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Is it liability/insurance, or something different?

I've made the decision to go back to school to get my CNM. As a former homebirther myself, the idea of attending homebirths appeals to me, but it seems very rare that CNMs attend homebirths - they seem to usually be CPMs or DEMs.

Just wondering if someone could shed some light into it for me.

Thanks in advance,

Kerry

Specializes in Emergency Department.

That bill is to legally recognize and license Certified Professional Midwives. CNMs can and do attend home births in IL.

Here is the link for SB 385.

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what area is this?

how does this crazy law read?

I live in Pittsburgh.

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Homebirth isn't illegal anywhere. You can't legislate place of birth. Otherwise we would have to throw those women who deliver by the side of the road in jail along with the planned homebirthers.

There may be legislation that does not allow CNMs to attend homebirths... although as I understand it that is usually not the case. Typically it is local politics and the availability of backup docs that determines this.

Rarely do the state boards restrict where or how an MD can practice so I am guess that your MDs are indicating the "medical risks" rather than the legal ones.

I didn't say homebirth was illegal; she asked why CNMs didn't do homebirths. It's illegal for CNMs attend homebirths in PA. I assume it's considered "practicing medicine" stepping-on-toes nonsense.

At any rate, I know there are D.L. midwives that practice homebirths here, and of course there are the Amish midwives, but good luck getting them to attend for the "English" (though some of the Mennonites might).

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At any rate. . .does any one know if there's any progress being made on this???

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Specializes in Maternal - Child Health.

From today's Omaha World Herald (Sunday, Feb. 14)

http://www.omaha.com/article/20100214/NEWS01/702149893

Bill would loosen midwife rules

By Rick Ruggles

WORLD-HERALD STAFF WRITER

Legislation that would loosen restrictions on certified nurse midwives appears to be in intensive care and in danger of dying in a legislative committee.

“They're tough odds,” said Autumn Cook, chairwoman of Nebraska Friends of Midwives, which is striving to move three bills through the State Legislature.

About 25 certified nurse midwives practice in Nebraska, most of them overseeing births or providing other services in hospitals such as the Nebraska Medical Center, Methodist Hospital, Creighton University Medical Center and St. Elizabeth Regional Medical Center in Lincoln.

The following bills are in the Health and Human Services Committee:

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— LB 481, which would remove the state ban against certified nurse midwives delivering babies in homes.

— LB 457, which would remove the requirement that midwives have a signed collaboration agreement with a physician.

— LB 406, which would add certified nurse midwives to the list of providers who can't be denied the right to be considered for hospital privileges solely because of her credential or title.

In Iowa, certified nurse midwives may do home births and function without a formal partnership with a physician.

The Nebraska Medical Association opposes the three bills. “It's a pure safety concern,” said Dr. Todd Pankratz, an obstetrician-gynecologist in Hastings. He serves on the NMA board....

Nebraska law allows women to have babies in their homes. So it doesn't make sense to forbid a certified nurse midwife from delivering babies in the home, said State Sen. Arnie Stuthman of Platte Center, a member of the committee in which the three bills are found....

But only two states, Alabama and Nebraska, don't let midwives oversee home deliveries. Nebraska is “neck-and-neck with Alabama for having the most backward midwifery laws on the books right now,” said Wisconsin's Katie Prown, campaign manager for the Big Push....

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Specializes in Ante-Intra-Postpartum, Post Gyne.
Homebirth isn't illegal anywhere. You can't legislate place of birth. Otherwise we would have to throw those women who deliver by the side of the road in jail along with the planned homebirthers.

There may be legislation that does not allow CNMs to attend homebirths... although as I understand it that is usually not the case. Typically it is local politics and the availability of backup docs that determines this.

Rarely do the state boards restrict where or how an MD can practice so I am guess that your MDs are indicating the "medical risks" rather than the legal ones.

Have you never heard of court ordered C/S?

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Specializes in Maternal - Child Health.
Have you never heard of court ordered C/S?

Can you elaborate?

I have heard of such, but only in extreme cases where the interests of the mother conflicted with those of the fetus and were well-known long before delivery.

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Liability insurance, physician backup, hospital privileging, and for some, truly believing that it is too risky and desiring to have help close at hand "just in case".

HeartsOpen: no, the state boards do not often restrict where MDs practice, but obviously their medmal insurers do. They'd be dropped like a hot potato or have their rates jacked up sky-high. And obviously the state can't absolutely restrict where birth happens, but they do license health care professionals. So in states where homebirth midwifery is severely restricted or illegal, a mother can definitely give birth at home. She just can't be assisted. This is how state laws are actually leading people to attempt "UCs" when they could be attended by competent professionals, or hiring unlicensed midwives who got their training who-knows-where and are not being held to any standard other than word of mouth.

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Specializes in OB.

That's what I was going to say... too hard to find a collaborating physician most places, I think.

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Yes they can. I had a CNM attended homebirth there 1.5 years ago and I have three friends in the Chicago area who own their own CNM homebirth businesses.

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CNM's can and do attend homebirths in Pennsylvania. The Pittsburgh area has no CNM's currently attending births at home because of the lack of physicians willing to be their collaborating physician. I live in the Pittsburgh area and know a couple CNM's who had homebirth practices many years ago. The eastern half of Pennsylvania has LOTS of homebirths with CNM's, but OB's seem to have a different attitude in that part of the state.

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Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
The eastern half of Pennsylvania has LOTS of homebirths with CNM's, but OB's seem to have a different attitude in that part of the state.

Is that Amish country?

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