TIME Examines Debate Surrounding Home Births, So-Called 'Direct-Entry' Midwives

Main Category: Nursing / Midwifery
Also Included In: Pregnancy / Obstetrics
Article Date: 14 Aug 2008 - 9:00 PDT

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TIME magazine recently examined the growing appeal of home births among pregnant women in the U.S. According to TIME, although home births only account for less than 1% of U.S. births, "there's a movement afoot to license more lay midwives to attend home births." The article was published online last week and is scheduled to be in the magazine's Aug. 18 issue.

The American Medical Association is urging lawmakers to curb the home-birthing movement, including calling for the licensing of "so-called direct-entry midwives" -- who do not have nursing degrees -- overseen by a state medical-practitioner board. Some home birth advocates contend that "fear of litigation has led to more women in labor being tethered to monitors and forced under the knife," and some women who choose home birth are pushing for the issue to be a civil rights matter. Joan Bryson, who has worked as a midwife in New York City for 17 years, said, "Legislating against home birth is totally un-American and unfair," adding, "We rank 42nd in the world in live births, and we spend more money than anyone else. You can't blame it on home birth."

Most planned home births are assisted by a midwife, although some people have favored so-called "free birthing" with no attendant, TIME reports. Home birth midwives say they accept only low-risk patients -- which excludes women with diabetes, high blood pressure, multiple births or any other risky condition. In addition, most midwives -- who typically charge from $1,000 to $5,000 per birth, significantly less than the cost of a hospital delivery -- travel with basic emergency medical equipment, including oxygen, resuscitation gear and medication to stop hemorrhaging. According to TIME, all home birth midwives "insist" that they practice preventively and know when and how to transport a woman to a hospital during an emergency.

However, Erin Tracy, an ob-gyn at Massachusetts General Hospital who authored two anti-home-birth resolutions approved by AMA in June, said, "Unless there's ready access to certain emergency personnel and equipment and even surgery, you're potentially endangering babies' and moms' health and lives." Tracy added, "We've all seen scenarios where mothers came in, after very major blood loss, in a very catastrophic state. By the time they arrive in the hospital, you're sort of behind the eight ball in trying to resuscitate these patients. The same thing with neonatal outcome."

TIME reports that after the majority of births moved to hospitals in the 1950s, the maternal mortality rate fell from 376 deaths per 100,000 live births in 1940 to 37.1 deaths per 100,000 live births in 1960. The most recent statistics show a rate of 15.1 deaths per 100,000 live births. A study published in 2005 in the British Medical Journal found that home birthing had a similar mortality rate to that of low-risk hospital births. However, other studies have suggested a two- or three-fold increase in the incidence of neonatal death among home-birthed infants.

According to TIME, in the "absence of clear data," some U.S. obstetricians are concerned about the "recent push by direct-entry midwives to receive licenses so they can practice their craft without fear of prosecution." Missouri recently reversed its 25-year ban on non-nurse midwives, and 20 states have similar legislation they are either introducing or planning. Some obstetricians "are trying to meet women halfway" through hospital-affiliated natural-birth centers, which often are located near regular hospitals and report low episiotomy and Caesarean section rates.

Former talk show host Ricki Lake -- whose documentary film, "The Business of Being Born," looks at the current maternity care system and at-home childbirth -- said, "It's amazing the technology we have. But we are losing the value of normal, natural birth" (Calhoun, TIME, 8/7).

Reprinted with kind permission from http://www.nationalpartnership.org. You can view the entire Daily Women's Health Policy Report, search the archives, or sign up for email delivery here. The Daily Women's Health Policy Report is a free service of the National Partnership for Women & Families, published by The Advisory Board Company.

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