As we consider licensing Certified Professional Midwives in Maryland, we are once again discussing the safety of home birth. Numerous peer reviewed, high quality studies have shown home birth with a trained attendant to be as safe as hospital birth for low risk women. Will we never put the home birth safety discussion to bed? When another home birth study was published in Britian in November of 2011 showing a slight risk in adverse outcomes for first time moms (there were no differences between second time moms who delivered at home or in a hospital), the home birth debate rekindled.
Let’s pretend for a moment that the results of the British November 2011 study results referenced above are applicable to the United States. The researchers of that study believe their results support a policy that allows home birth for healthy first time moms.
But it isn’t only first time moms that make “risky” decisions. Moms and dads make daily decisions that incur a slightly greater risk for our children. We choose to vaccinate, nudge them out the door on their first solo walk to school, sign them up for swimming lessons, and drive seventy miles an hour with them in the back seat. Why choose activities that bring more risk? Sometimes we choose increased risk because we are looking at the bigger picture and a better quality of life for our child. For example, if you are a first time mom, while there may be a slight increase in risk with home birth (according to one study), your chances of cesarean delivery are significantly reduced. There is a much lower risk of maternal death with vaginal birth. And I think we can all agree that a child’s quality of life is improved when their mother is around to parent them.
With other choices, such as the decision to vaccinate, we are choosing an immediate increase in risk (the risk of a reaction to the vaccine) in order to decrease future risk (the risk of acquiring a life-threatening illness). Many moms choose the (potentially) increased immediate risk of home birth as a first time mom in exchange for the decreased future risk of complications in subsequent pregnancies (due to the fact that women are less likely to have a cesarean if they give birth at home).
I am very familiar with this game of trading risks. When pregnant with our second child, my husband and I decided to attempt a vaginal birth after cesarean (VBAC) at home. Why at home? Given the high cesarean rate at area hospitals, coupled with the requirement for continuous monitoring (which is linked to a higher cesarean rate), and my inability to feel at ease in a hospital when I am not sick, we thought my chances of vaginal birth in a hospital were slim to none. I traded the risk of a repeat cesarean section in a hospital for the miniscule risk of a uterine rupture at home. It is important to note that the risk of uterine rupture, less then .5% in some studies, is not completely eliminated by being in a hospital.
My successful VBAC at home greatly reduced the risks of future pregnancies (for example, placental abnormalities and stillbirth increase with multiple cesarean sections). I realize that IF I had undergone a cesarean with my second, I would most likely have had a cesarean with my third and fourth pregnancies, not at all a safe proposition for myself OR my babies.
Other discussions in the homebirth debate center around certain “dangerous” midwives doing things which the medical community absolutely does not approve. It is apparently the midwives’ job to ensure patient compliance with the “standard of care,” care which is often not evidence based. This is a patronizing attitude. It is time that women take back their responsibility for birth. We need to speak up. This is not about the midwives, this is about real options for women.
An OB friend informed me that had I chosen a hospital with my fourth child, he would have been born by cesarean. The rationale was that my fourth was a face presentation, and that I had a previous cesarean (even though it was followed by two vaginal births). The old textbooks say a cesarean is not indicated for a face presentation when the chin is facing anterior (which my baby’s was), and the baby is smoothly navigating the birth canal. WHY did I need a cesarean?
I do have a suggestion for Maryland folks who are worried about the moms who will choose to have a VBAC or breech or ______ birth at home. Legislation for licensure could require a written informed consent process for moms that choose to decline the standard of care. Perhaps legislators will understand, when they have the opportunity to review detailed written informed consent documents, that this is not about the midwives, this is about the moms. If my midwife had given me an informed consent document to sign when I was in labor with my fourth baby, I absolutely would have signed it. Pushing my baby out at home was my decision, not my midwives’. My midwives are the experts, there to guide me through the process, but I am the decision-maker, I am ultimately responsible for birthing and raising my baby.
Women have the right to choose to birth at home, clearly a safe option with a trained attendant. The problem is that in Maryland, we have few trained attendants offering home birth. Most Certified Professional Midwives who live in or near Maryland will not practice in Maryland. And only a handful of Certified Nurse Midwives will attend home birth in Maryland (according to the Feb. 3 2011 ACNM issue brief, only 3.8% of CNMs attend out of hospital birth.) Last summer, I was pregnant with my fourth child at a time when finding a home birth midwife was next to impossible. Several of my friends, were in their last trimester and scrambling for a midwife. I know moms who gave birth at home unassisted. Other moms traveled to Va to have their baby. This is not an ideal situation.
Enough with the endless banter on homebirth safety. Home birth IS safe with a trained assistant. The Certified Professional Midwife is the only midwifery credential that requires knowledge about and experience in out -of-hospital settings. Maryland families, it is time to stand up and tell our legislators that we want access to licensed Certified Professional Midwives. It is time to stand up and take back the responsibility for our births. Together, let’s support HB1056 and license Certified Professional Midwives in Maryland. Please visit Maryland Families for Safe Birth and get involved. Donations are welcomed and can be made on the Maryland Families for Safe Birth website.