| |
|
Virginia,
All I Want Is a Safe Birth at Home
When I became pregnant four years ago, I knew I wanted to give birth in the comfort of my own home with a trained midwife by my side to guide me through the stages of labor, keep a skilled watch over a natural process that is occasionally risky and catch my baby as he was born. I had even seriously thought about becoming a homebirth midwife myself. Neither, it turns out, is an easy thing to accomplish in Virginia -- or in Maryland or the District for that matter, or in the six other states most hostile to lay midwifery. In these states, not only is there no provision for licensing autonomous midwives trained in out-of-hospital births, such midwives are illegal. It is perfectly legal to give birth at home in Virginia, but the midwives trained to assist with homebirths, known in most states as Certified Professional Midwives (CPMs), are not recognized here. Only doctor-supervised midwives first trained as nurses may offer midwifery services, which is why in the vast majority of cases, the birth has to take place in a hospital. To give birth at home, I had no choice but to hire an unlicensed, underground midwife, one who risked prosecution by tending to me. Now, as I make plans to have another baby, even that option is getting more difficult. The midwife I used before is no longer practicing. And here in Virginia, legislation that would have allowed for licensing CPMs has been defeated two years in a row -- in part because of the objections of the medical profession. But the drive toward nationwide acceptance of the CPMs seems at last to have gained momentum. Since 1994 when it first became available, 15 states have accepted the North American Registry of Midwives' CPM credential, three in the past two years. And last month the American Public Health Association for the first time published a statement of support for CPMs and urged state legislatures to legalize independent midwifery. The law in Virginia, the example I know best, was not always this restrictive. In 1976, before legislators criminalized midwifery except by nurse midwives, the state issued 650 permits to homebirth midwives. The number of "grandmothered" permit holders has dwindled over the years, and today, only one, 62-year-old Adela Scott Wilson of Virginia Beach, continues her work. She has no plans to retire. "I wouldn't know how," she says. But Wilson can't serve the entire state and sees danger in the lack of access to legal midwives for homebirths. "It's not fair to deny women access to good care, and underground care is not good care." None of this means that Virginians have stopped giving birth at home. The state's Department of Health reports that about 500 women bore babies at home in 1999. Presumably, a large number of these births are assisted by illegal midwives. "Women want to and will have babies at home," says Ellen Hamblet, coordinator of Virginia Birthing Freedom, a grass-roots organization. "The only thing increasing risk to them is midwifery's forced underground nature." Families choose homebirth because they are convinced that babies and mothers do better without the epidurals, episiotomies, electronic monitoring, drug use, labor inducement and Caesarean delivery too-often commonplace in hospital births. An at-home birth costs less than a third as much as a hospital birth, but it must be paid for out-of-pocket when the midwife is unlicensed. In states where licensing is possible, a CPM must receive extensive training, and pass competency evaluations and a certifying examination. As popular pressure for licensing legislation has intensified, much of the opposition has come from state ob/gyn societies. The Virginia society, in lobbying against licensing, emphasized that even uncomplicated pregnancies can be risky and said that all births should therefore be hospital births. But at the hearings, the organization offered no evidence showing homebirth to be less safe than hospital birth. "Their testimony has been short on context and data," said Hamblet, "and limited to sharing scary stories about what can go wrong during a birth." The commissioner of the state's Department of Health, Anne Peterson, herself a physician, helped defeat the legislation this year because of concerns about oversight and safety. These opponents, including the American College of Obstetrician/Gynecologists (ACOG), which continues to lobby against the licensing of CPMs, are overstating the risks. ACOG, using Virginia data, claims that during labor, unexpected medical emergencies arise in 10 percent of otherwise uncomplicated pregnancies. But midwives say that less than a third of such emergencies in homebirths require transfer to a hospital. ACOG maintains that the risk necessitates that all births be in hospitals, and that public access to midwifery be limited by the medical profession's willingness to sponsor and supervise midwives in hospital settings. But last year at a Virginia Senate Education and Health subcommittee meeting, when asked if he had any evidence showing that homebirth is unsafe, an ACOG representative replied, "No. No evidence." It seems clear to me that there's an element of self-interest in ACOG's opposition. It belies a lack of appreciation of the training CPMs receive to manage unforeseen complications, as well as an overestimation of the danger of homebirths. In a nation now generally out of touch with non-medical perspectives on birth, midwife malfeasance makes great headlines. But lay midwives seem to handle those unexpected medical emergencies well: If 10 percent of homebirth mothers or babies were suffering injury or death, wouldn't we hear about it? In Virginia, where hospitals are not required to disclose the number of hospital childbirth deaths, it is impossible to compare death rates associated with home births vs. those associated with hospital births. Virginia's failure to license CPMs is ironic given that the state legislature's own Joint Commission on Health Care reported in 1999 that "no empirical evidence show(s) hospital births to be safer than homebirth." Judith Rooks, an epidemiologist and midwifery expert, says that "the overall evidence indicates that homebirths attended by either midwives or doctors can be as safe as in-hospital births," assuming competent midwives, easily accessible obstetrical backup, clear, universally accepted protocols and no disincentives to transferring women to hospitals. As I well know, women who want to deliver at home with a midwife will do so whether it is legal or not. And if there are risks involved, aren't they compounded when the only option is an unlicensed midwife? Licensing could reduce birth-related health risks by making coordination between CPMs and the medical community possible. "We're 100 percent behind the idea of midwives working closely with doctors," says Hamblet, "but in a collaborative, not a subordinate role." When I have my next baby with a midwife at home, if something should go wrong, I want an ob/gyn at my local hospital to be available -- someone who knows my history and is prepared to intervene quickly. That kind of collaboration is impossible as long as my midwife is illegal. Jennifer Downey is a freelance writer. |
|
||||||||||||||||||
