The question of my stance on home birth has been raised by several. I can only assume this question stems from my recent change from seeking out my license as a CPM (Certified Professional Midwife), and seeking out my degree as a CNM (Certified Nurse Midwife).
I most definitely have not changed my stance on home birth. I am still a firm believe in a woman's choice to birth in whatever environment she likes and I plan to support a woman's choice no matter where she plans to birth., providing she meets the requirements to categorize her as 'low risk'. In fact, not only do I support home birth, but I plan to attend them as well. In South Carolina, CNMs do not attend home birth, but attend births only in hospital and freestanding birth centers. However, North Carolina CNMs may attend births at home, a freestanding birth center, or in hospital. My plan is to become licensed as a CNM in both the state of South Carolina, and in North Carolina since I am so close to the state line. This gives me such a wide variety of options for home births, births in a freestanding birth center, as well as hospital births. I have the option of offering out of hospital births to qualified women and having their insurance pay for it as well. As a CNM, I feel like I will be able to reach so many more women than if I were only a CPM. This is another huge reason for my recent decision regarding my education.
Choosing to become a CNM instead of a CPM does not automatically equate me as anti-homebirth. I am not anti-homebirth, but I am pro safe birth. I believe a woman can have a safe, amazing birth experience in a birth center, at home, and even in the hospital. Do I believe that women who choose to birth with a CPM are not choosing 'safe birth'? No, not at all. There are plenty of wonderful, qualified, well-trained CPMs who have a sharp eye and a kind heart. There are also many under-qualified, uneducated, unregulated CPMs that do not provide a safe birthing environment. I am most certainly not anti-CPM, and I never will be. Just because I have decided to go another route does not mean this at all. Do I believe there are women out there who are birthing out of hospital that should not be? Absolutely. Homebirth, I believe, should be reserved for those who are 'low risk'. The term "low risk" is such a variable as everyone has a different opinion on what that means. To most OB's, a VBAC (Vaginal Birth After Cesarean) is not considered to be "low risk". However, to me, because the risk of a complication from a VBAC is less than 1%, I still consider that to be "low risk". Most would agree that issues such as presentations besides vertex (breech, ect.), multiples, and certain maternal conditions are considered "high risk", though many still attend out of hospital births for these women. I can not say I am in 100% agreement with this. I personally believe there should not be an across the board answer, but each situation considered on a case by case basis. I am a firm believer that a women who has had a complication free pregnancy, no known issues with her or her baby, has a baby in a good position, and goes into spontaneous labor is a prime candidate for a home birth. I do not, however, believe a women who is having twins, both of which are breech, and is developing high blood pressure is considered "low risk" and should be birthing at home. Many will agree with me, and many will not. Again, we all have our opinions on what "low risk" means and we all have to make the best decisions for ourselves and our specific situation.
I say all this to clarify that I have not, nor will I ever, be anti-homebirth. I believe home birth is a safe, natural, and beautiful thing with a skilled, qualified attendant and I will be honored to attend many home births in the future.
7 comments:
Amber, I think you are going to be an amazing midwife. You are going to help many mothers and babies come safely into the world. My experience with my CPMs was amazing. They are part of practice so they did take insurance. They were always available anytime I needed them and came to my house within ten minutes after I called them when I went into labor. They followed up with me for 6 weeks after giving birth. checking on me everyday for the 1st three days after giving birth. They checked my diet carefully to make sure I was getting enough protein, carbs and nutrients. They addressed all concerns, treated me with respect and care and were all in all amazing care providers. It makes me sad when I read people bashing CPMs. NOT ALL CPMs are careless and reckless. My CPMs had STRICT guidlines they followed. They only took low risk women. I just wanted to say I think you will be awesome, just like my midwives were. I do hope you do homebirths because women like me need the option to do it and to do it safely. Thank you.
Anonymous - Thank you. My prayer is that I will be an amazing midwife as well! I'm so glad that you had a great experience with CPMs!! I hope you do not think I am bashing all CPMs in general, because I'm not and I tried my best to make that blatantly obvious. I think there are wonderful CPMs and I think there are dangerous ones. The problem however, is that because there are no country-wide regulations (it varies so much - some states it is legal, some it is not, ect), and no database telling if a particular CPM has an alleged or convicted negligence issue - there is simply no way to know the bad from the good. This, in turn, harms many moms and babies. I appreciate your thoughts and I do agree with you 100%. I just wish a system and standards were put into place.
Temporarily anonymous again. :)
There are several CNMs in my state who practice outside of hospitals. I plan on being one of them.
CNM /= anti-homebirth!
Anonymous #2 - I'd love for you to reveal your identity one day! I enjoy knowing who I'm speaking with! Unfortunately, there are no CNMs who do homebirths in SC (at least not that I'm aware of) though there are some that run a free standing birth center down in Charleston, SC. In North Carolina however, there are quite a few CNMs who have OB backup and do home births as well as births in a free standing birth center. I would love to be able to be licensed and registered in NC and be a part of that!
What about the mother's right to choose a home birth? What happens to her rights when the "governing bodies" decide that she is not low risk? A woman has the right to choose where to birth her baby; and that trumps all else. Once regulations begin to dictate where mothers can and can not birth all is lost, be it CNM or CPM.
Anonymous #3 - A mother will always have the right to birth in whatever location she sees fit - that is a right of living in a free country. However, if there were more stringent guidelines placed for traditional midwives, it would "risk out" many women from being attended by CPMs or DEMs. You, and many others view that as a bad thing. I do not share in those feelings.
I fully believe that one of the reasons traditional midwives have a THREE FOLD death rate is because the accept women who have no business birthing at home! Women who have had 3 previous cesarean sections, who are carrying multiples, who have GD or uncontrolled BP issues, ect. Regulations would protect these mothers and babies and put them in the place they need to be with the care provider they need to see.
You said - "A woman has the right to choose where to birth her baby; and that trumps all else."
That is CLASSIC NCB (Natural Childbirth) rhetoric. Makes it sound like the "where's" and "how'" and the "experience" trump having a healthy, live baby.
You also said - "Once regulations begin to dictate where mothers can and can not birth all is lost, be it CNM or CPM."
That is ludicrous. Once regulations and standards are put in place for traditional midwives, we may very well see a decrease in the death rates for out of hospital deliveries!
fantastic. you ARE going to be a wonderful midwife. i'd seek you out for my homebirth if i lived in north carolina. ;)
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