opinions about homebirthing

Specialties Ob/Gyn

Published

I have a few friends who've decided to have homebirths. I'm curious about this seemingly growing trend. I'd love to hear some opinions from those who've done it, participated in it, and delivered some of these babies at home.

TIA!! :redpinkhe

Specializes in Emergency Department.
Licensed professionals attending homebirths is not illegal anywhere

Actually in some places it is illegal for a CNM to attend a home birth. South Dakota has recently enacted a 'pilot law' to allow CNMs to attend home births until 2013, but prior to that it was illegal for them. Nebraska does not allow CNMs to attend home births, but they have been working hard to change that.

Practicing midwifery may be "alegal" meaning there is no legislation against it, just no licensing process, or they may be illegal meaning that there are laws in place with penalties for those practicing midwifery.

Alegal is a term that doesn't exist, direct-entry midwives are either regulated or not. This chart shows the 24 states where midwives are regulated, the rest are unregulated. If she is in an unregulated state other than one where midwifery is outright illegal, it is the same thing as practicing without a license. Example: Pennsylvania is an unregulated state and while it seems safe because it is not outright illegal, time and time again direct-entry midwives are being brought up on charges of practicing medicine and/or midwifery without a license.

Thank you for the opportunity to discuss this and hopefully provide some helpful information regarding midwives of all varieties in all settings. For the last 11 years this has been my focus!

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Specializes in Rural Health.

Actually, I totally spoke out of terms, apparently on 6-25-08 they have overturned a previous decisions regarding home births and CPM and now they are in fact "legal" in my state. A new law was actually passed in 2007 which allowed home births to be attended by CPM's and for CPM's to actually be recognized as providers of midwifery but then the state put a stay on that law and everything came to a grinding halt for fear of criminal charges and/or jail terms and fines.

The AMA took a stance immediately after the 2007 law was passed regarding CPM's and they asked for a stay. A stay was granted last year based on the statement of the AMA that midwives were practicing without a license by attending a home birth.

Sure there were home births galore taking place but it all became underground this last year because if you were "caught" at the bedside providing care to your mom and/or baby during a birth, yes it was illegal. Hence home births in a sense were "illegal".

There were some gray lines regarding whether or not CNM's were encompassed into this practicing without a license (home births only) so the few that I know just stopped doing home births here in MO. In fact I am about 99% sure that there were only 2 CNM's in the entire state that would do a home birth. Two of the CNM's I know in particular went into practice in AR where it is not heavily regulated and placed their clinic on the boarder in a rural area so they specifically could focus and get patients who wanted home births. They made their clinic into a "home" in AR and that is where the practice. Awesome, it really is.

Obviously no longer "illegal" according to the MO Supreme Court but I anticipate many years of uphill fighting for CPM's as well as CNM's to continue to attend home births without the fear of the AMA crashing down on them again.

Here is a link to the article:

http://www.iht.com/articles/ap/2008/06/25/america/Missouri-Midwives.php

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Specializes in Emergency Department.
Obviously no longer "illegal" according to the MO Supreme Court but I anticipate many years of uphill fighting for CPM's as well as CNM's to continue to attend home births without the fear of the AMA crashing down on them again.

They are legal now and according to the Supreme Court, "The court's majority said the Missouri State Medical Association and three other medical groups had no legal standing to sue in the first place." It would be very unusual to make them illegal again following this. Licensing allows the state to keep track of who is out there practicing and making them illegal forces them underground once again and poses a "public health threat". One official in California once said in paraphrase during a phone call I heard with my own ears, "We give licenses to midwives so we know where they live when its time to arrest them."

The AMA said this in reply: "We've decided that we are not going to make a motion for a rehearing," said Tom Holloway, director of government relations for the Missouri State Medical Association, in a phone message on Monday. "I think we're just going to let it go and explore our other options." While they declined to state it, options include making it hell for midwives to integrate into the system from licensing requirements to practice agreements to scope of practice to making transfers to hospital difficult for midwife and mother.

Ahhhhhh, the calling to midwifery requires one also be politically aware. Sigh.

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Specializes in Rural Health.

I don't anticipate this becoming "illegal" again in MO but I agree with you, I anticipate years of uphill battles and while the AMA appears to be playing nice, deep down we all know they probably aren't ever going to play nice. This quote below just says it all.......

"That's just bad news for the patients," said Tom Holloway, a lobbyist for the medical association. "The way this law is written, any person that has some sort of very undefined certificate to practice anything related to child birth is going to be able to provide unlimited services related to pregnancy — C-sections, drugs, epidural anesthesia and even abortions — without any state regulation or oversight whatsoever."

He doesn't even know what CPM's practice or how their scope of practice is even defined. I would think some research in the matter would've been in order. They were so quick to file a stay when this law was passed but yet never knew the scope of practice they were questioning.

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Ahhhhhh, the calling to midwifery requires one also be politically aware. Sigh.

So true. Our MW (CPM) was constantly attending conferences reguarding legislation on the practice midwifery. Can I ask what kind of MW you are?

To be honest our country is doing women a HUGE disservice by making it difficult to have birth options in certain states. Think of how much money our government could save if they offered the option of allowing mothers on medicaid to have homebirths or birth centers?

THankfully our state has little legislation on homebirths and I truely hope it remains that way. Altho for safety of everyone I'd love to see a licensing system set up similar to nursing so patients can verify creditials online.

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Specializes in Emergency Department.
Altho for safety of everyone I'd love to see a licensing system set up similar to nursing so patients can verify creditials online.

In states where licenses are issued to qualified direct-entry midwives, it is exactly that way. :wink2:

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In states where licenses are issued to qualified direct-entry midwives, it is exactly that way. :wink2:

Yes would be nice if that was required in all 50 states :p

So is the AMA and ACOG going to stop attempting legislation to prevent homebirths now? Last I heard they wanted it to be in accredited birth centers that were attached to hospitals with CNM only or in hospitals. I've been a tad out of the loop since having my son...

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Specializes in Ante-Intra-Postpartum, Post Gyne.
think of how much money our government could save if they offered the option of allowing mothers on medicaid to have homebirths or birth centers?

.

stats complied by marsden wagner md, consultant for who (2001):

average cost of midwife-attended birth in the us: $ 1,200

average cost of physician-attended birth in the us: $ 4,200

health care cost savings if midwifery care were utilized for 75% of us births (currently 4%): $1.5 billion/year

health care cost saving by extending midwifery care and demedicalizing birth in the us: $13-20 billion/year

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I would really love to see options of any kind! In OK you either go to the hospital or stay home. And as much as I love homebirths, some of my clients would benefit from the third option, the birthing center. We have lost one after another in this state and it's sad. In Dec 2006 a well known center closed and left many rural families with zero options due to the lack of available midwives for homebirths. I helped a few clients at this particular center and they seemed more at ease there than at home. Maybe because the environment is a little more controlled and "stuff" is available.

The CNMs at OU are wonderful and try to create a home-away-from-home environment in the hospital. And we have two professional midwifery practices, both offer homebirths.

I just think there can be a happy medium, as I'm sure many of you already have in your state.

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Specializes in Emergency Department.
Yes would be nice if that was required in all 50 states :p

So is the AMA and ACOG going to stop attempting legislation to prevent homebirths now? Last I heard they wanted it to be in accredited birth centers that were attached to hospitals with CNM only or in hospitals. I've been a tad out of the loop since having my son...

What they aim to do is anyone's guess at the moment considering their recent statements/resolutions regarding midwives and advanced practice nurses (doctorates).

The funniest thing ever is they say in their statements on birth centers they fully support those that are accredited by the American Association of Birth Centers. What they don't realize is that according to the guidelines drawn by the AABC, a birth center that is fully accredited more closely resembles your home (as a "maxi home") than a [mini] hospital. It's designed that way! If the birth center is set up correctly and run according to the plan, it is your midwife's house, not yours :chuckle Must be something in that indoctrination that going somewhere to give birth is better than staying at home ;)

But shhh, they haven't noticed so I might happily run an AABC birth center someday in the near future :D

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What they aim to do is anyone's guess at the moment considering their recent statements/resolutions regarding midwives and advanced practice nurses (doctorates).

The funniest thing ever is they say in their statements on birth centers they fully support those that are accredited by the American Association of Birth Centers. What they don't realize is that according to the guidelines drawn by the AABC, a birth center that is fully accredited more closely resembles your home (as a "maxi home") than a [mini] hospital. It's designed that way! If the birth center is set up correctly and run according to the plan, it is your midwife's house, not yours :chuckle Must be something in that indoctrination that going somewhere to give birth is better than staying at home ;)

But shhh, they haven't noticed so I might happily run an AABC birth center someday in the near future :D

ITA with this. I can never understand why going to what is essentially another house is okay but being in your own house is not. I think birth centers are wonderful and I would love to run one someday but I cannot understand the idea that they are somehow safer. I'm sure they are safer than some home setups, but not the majority. And they involve getting in your car and going somewhere in labor versus staying put. My hospital doesn't even have 24-hour OB or anesthesia coverage so I am no better off there than I am at home, really. Too bad ACOG and the AMA can't look beyond $$$ and politics and think about how ridiculous their statements are.

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Regardless of the "set up" of the birth center- because we used to have one called The Cottage which was essentially a house-some feel more at ease at the midwife's house/BC.

I have worked with women who thought they wanted to stay at home but just had some deep fear that kept coming out. (not hard in a society of fear)...as a doula I am not there to "talk them into" anything only to educate, support, and help facilitate their plans.

I have found with many things, even labor, that if you go against your gut feeling, things don't go easily. So a woman who is not fully comfortable at her home for birth needs to be where she is comfortable and able to allow her mind/body to work.

Why have so many women gone to "The Farm"- it's a home away from home, not a mini hospital? For some their own home is just not the right place- and that's perfectly Okay.

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