States Respond To Increasing Demand For Midwives, Home Births

Main Category: Pregnancy / Obstetrics
Also Included In: Nursing / Midwifery
Article Date: 27 Sep 2010 - 0:00 PDT


An increasing number of pregnant women are eschewing hospital deliveries for home births, prompting some states to consider legislation to license midwives who assist in home deliveries, the New York Times reports.

The number of home births in the U.S. rose by 5% from 2004 to 2005 and held steady at 25,000 in 2006, the last year for which data are available, according to the National Center for Health Statistics. Women who opt for home births cite several reasons, such as religious beliefs or a desire to avoid a caesarean section. A 2008 report co-authored by Childbirth Connection -- a not-for-profit maternal health research organization -- found that medical interventions have increased significantly in the past 20 years, including interventions in low-risk pregnancies. The report said that the number of induced labors doubled from 1990 to 2005, while c-sections rose from 4.5% of U.S. hospital births in 1965 to a current 40%.

Midwifery advocates argue that recent figures showing an increase in the U.S. maternal mortality rate supports their position that a majority of c-sections are unnecessary and possibly dangerous. However, some physicians and medical groups argue that home births carry higher risks than hospital births. Jacques Abramowicz, co-director of Rush University Medical Center's Fetal and Neonatal Medicine Center and a fellow of the American College of Obstetricians and Gynecologists, said, "Childbirth is very dynamic, and it can be a very dangerous process." He added, "In the vast majority of cases, nothing happens. However, if an emergency occurs, it happens very fast -- in two, three, four minutes."

Illinois Legislature Considering Midwife-Certification Bill

The issue of how to regulate midwives is playing out in Illinois, where the state Legislature is considering a bill (HB 226) that would license direct-entry midwives, who do not have nursing degrees, the Times reports. Illinois law considers legal home births to be those attended by a physician or a nurse midwife, an advanced-practice nurse with a secondary degree in midwifery.

Home births in Illinois account for 700 to 1,000 births each year, many of them in rural areas, where obstetricians are scarce, according to the state Department of Vital Health Statistics. Licensed home-birth attendants work in only seven of Illinois' 102 counties, leaving a majority of the state home births unattended or attended illegally by someone whose license and education are unregulated. According to the Times, women often register home births as "unassisted" to avoid scrutiny of their midwives.

Supporters of the Home Birth Safety Act -- which passed the Senate in May and is pending in the House -- argue that it strengthens and protects pregnant women and their infants from untrained practitioners. It also allows midwives to practice openly and transport pregnant women to hospitals in emergency cases without fear of reprisal or arrest. Opponents of the measure -- including ACOG, the Illinois State Medical Society and the American Medical Association -- argue that home births are riskier than births in medical settings.

Illinois' midwifery organizations are cautiously optimistic that the measure will pass. Rachel Dolan Wickersham, president of the Coalition for Illinois Midwifery and vice president of the Illinois Council of Certified Professional Midwives, said medical groups' opposition to the measure is "about power and control." She added, "These women are going to have babies at home," adding, "Why would anyone want to keep the situation so that the person attending them has no regulated training or is afraid to transport them to a hospital in an emergency?" (Reaves, New York Times, 9/24).

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.

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