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On no particular day in the 1940s, the headlines of the newspaper—in large font with dark black ink that stayed on your fingers—were probably centered around World War II. Intermittently you could find mention of the things that “everyone” was doing: flinging the newly invented Frisbee, watching with wonder the new sport of roller derby, and giving birth in a hospital.
Prior to the advent of modern medicine, no one went to a hospital to have a baby, and then for years after it was only the wealthy that did. Attended by other women—some of whom were trained midwives and some who just learned the ropes through experience—new moms labored at home. Throughout time, training in midwifery emerged, obstetricians appeared, pain relief was invented, medical licensure was sought out, and, by the middle of the 20th century, hospitals had bustling maternity wards where doctors were catching babies in what was touted as the safer and more necessary environment. Moms were sold on the idea, at least most of them were.
But it’s no secret that thousands of women still don’t buy that a hospital is the ideal place for birthing babies; in 2008, some 28,000 planned home births took place in the US. And while that is only 1% of the 4.2 million births annual births in our country, there is evidence that home births are back on the rise. But why not birth in a hospital? What does home birth have that the well-equipped hospital doesn’t?
Heather Dove is a local mom whose two daughters were both born in Easton: one at home, the other at the hospital. Following her inclination towards all things natural and organic, birthing a baby at home without unnecessary medications or surgery felt right to Heather. “I had read a ton of birth stories on the site Mothering. I knew I could do it, and I didn't want painkillers making me or the baby groggy or interventions leading to the impaired ability to push and ending up with a C-section.”
This idea of women seeking home birth as a refuge from unnecessary interventions may be the impetus behind the 20% rise seen in home births from 2004 to 2008, says Dr. MacDorman, lead author in the recently released study on the increase in home births. But just as navigating the pros and cons of medical interventions is tricky, finding a home birth midwife that will come to the Easton area is equally precarious.
Five years ago when Heather was pregnant with her first daughter, she had to do some calling around before finding a midwife in Baltimore who was willing to make the drive to the Eastern Shore. Three years later that same midwife was unable to attend her second birth, so Heather gave birth at Memorial Hospital at Easton, arriving just in time to push after laboring at home. A Google search today yielded about a handful of licensed, legal midwives in the Maryland/DC area, but none close enough to agree to attend a homebirth in Easton. Where are all of the midwives?
There are 27 states that offer licensing or formal recognition of certified professional midwives (CPMs), the biggest group of midwives trained to perform home births. Maryland is not one of them. In these other 23 states, a CPM, who is nationally certified by the North American Registry of Midwives, is at risk of getting arrested for delivering a baby. Certified nurse-midwives (CNM), the other main group, have more advanced credentials and can practice in all states, yet its members deliver almost exclusively at hospitals or birth centers.
In some cases CPMs continue to attend home births, risking legal prosecution for not having licensure. That is partly why finding a home birth midwife is difficult; they try to stay under the radar in a state like ours. CNMs, meanwhile, find it difficult to keep up with not only the expensive malpractice insurance they have to purchase in order to attend home births, but also to find a physician willing to collaborate with them.
The American College of Obstetrics and Gynecology does not support home birth, though they do give suggestions on safety during the practice of home birth, including limiting the practice to low-risk women only.
Heather felt confident in the experience her CPM brought to the birth of her first daughter at home, as do many women who seek out these practicioners. Midwives aren’t just lay people who know the right way to slap a brand new baby's bottom. They come prepared with not only experience and training, but a bag full of fetal monitoring equipment, sterile instruments, IV equipment, and even oxygen tanks, among other things. They deliver prenatal care to mothers, sometimes in the comfort of their own homes. More importantly, they come prepared to nurture the mother and treat labor and birth as a natural process.
Heather remembers: “I labored in a birth tub which was lovely and eased the pain so much. I look back on the day—12 plus hours of laboring—with great memories. I'm sure hospital birth has many benefits for riskier pregnancies. For me, the only big benefit was room service.”
Read Part I of Patty's series on birthing options, "Pushing VBACs Out."