Making Home Birth Safer

I never sign these things. I am not one to get all up in arms about petitions and change and such–unless I feel strongly about it. And maybe there just hasn’t been a petition out there that has stirred me so much, until now. The Coalition for Safer Home Birth was started on Change.org to encourage our legislatures to recognize the safety standards that are lacking in home birth. The coalition does a wonderful job summarizing exactly where the issues in home birth safety rest which largely is in the hands of the home birth midwife who is lacking a certain level of education. I feel that it is best for me to leave you to read what the coalition has written as I could not have said it any better so I won’t even try.

And maybe, if you feel moved enough, if you want to see change, sign the petition.

Protect Mother’s and Babies: The Coalition for Safer Home Birth

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we need GREAT midwives

This post is coming to you as I have had several days to think about the amazing reactions I’ve had to my most recent post My Thoughts on Home Births. The thing about midwifery is that there are way too many distinctions of different kinds of midwives. Just a few: Lay, Direct Entry, Certified Professional Midwife and Certified Nurse Midwife….the only thing you need to know is that a CNM is the ONLY type of midwife with a clinical degree in nursing. That means she (or he in some places!) has a high school diploma, bachelors in nursing, masters in nursing and nurse midwifery certifications and degrees. I’m taking a rather slow and easy road to midwifery, but if one is on the normal track to becoming a midwife straight out of high school, then she will have been in school for at least 6 years, if not more in some cases. She also must take continuing education in basic life support, neonatal resuscitation, suturing, etc. CPMs, Lay, and Direct Entry midwives may have some pre recs to take before entering a program and in less than 3 years they could be on their own catching babies, mostly at home. Those midwives are not certified to work in a hospital or in some birthing centers. All this to say…education makes a huge difference and as I said in the last post about home birth, I am a HUGE advocate for education, both of the provider and the patient.

I say this because, despite my not being a fan of home birth, our country still needs good great home birth midwives. People who want to give birth at home, educated or not, are going to give birth at home and they should do so with a great midwife. The most ideal home birth midwife would be a CNM. I know a few CNMs who actually attend births at home. This area gets sticky depending on different state regs, but in Colorado, it is allowable. Now, does she carry liability insurance? Probably not because it is too expensive to do so. Would I hire a midwife to attend my birth without liability insurance? No, because that also means that my insurance is most likely not going to cover a dime. Regardless, we need to accept that, while home birth is not the safest place to have a baby, that it’s still going to happen and they need to be attended by great home birth midwives.

What does a great home birth midwife look like? In a perfect world, she is a CNM and has experience working in a hospital setting. She has a relationship with the local hospital in which transferring is not looked at with such negativity and she carries liability insurance. She carries a post-patrum hemorrhage kit with her, along with a tank of O2, an IV kit with plenty of fluids and oxytocin. She has THREE assistants..not just one or two. These are also CNMs who have just as much experience and understanding in labor, birth, and newborn care. She also only takes on truly low-risk moms. In a perfect world, right? For now, our focus should be on having the same standard of midwifery care at home as we do in the hospital. That scope needs to include the same amount of schooling and continuing education that is required of CNMs today. If you know anything about education, you also know that those standards change constantly and in my experience, become more thorough and strict. That is great! Midwifery is a profession just like any other and you wouldn’t hire someone who was not fully educated to take care of you and your baby, right?

The reason we need great home birth midwives is because we need to lessen the number of neonatal deaths. Since families are going to make that choice whether I agree with them or not, we still need to have educated, great midwives attending those births. We need to continue to hold midwives accountable who have had deaths or complications made because of their lack of education or preparedness.

Remember, we don’t want to bury our babies twice, or even once if we can! #notburiedtwice

my thoughts on home births

I have thought long and hard about writing a post like this. It’s a touchy subject, especially in the natural childbirth (NCB) arena and I’m still having a hard time finding my words but I’ll try.

When I was pregnant with Logan, I had no desire to ever enter the medical field other than working in administration. When I was 28 weeks, we watched The Business of Being Born and I thought my world was turned upside down. I cannot explain how one documentary on childbirth, home birth, and how OBs are only surgeons, changed my mind in 90 minutes and made me question every decision we had made up until that point about our care. We were with an OB office and had a decent, uncomplicated experience so far. We had started going to natural Bradley Method childbirth classes and learning more about the birthing process. But as I reflect on that time almost 5 years ago, I am dumbfounded how easily influenced I was, and how I tried to manipulate my  husband into thinking that a home birth was the only way and that hospitals were just a place where they wanted to perform all these interventions so they could get more money.

Um….crazy thoughts, right??

Even still, we checked into our insurance options and switching providers and to a home birth was not something our insurance would cover. Good thing since our son had a spontaneous pneumothorax at birth. When I shared this with a local home birth midwife recently, she said it must have happened when they tried to suction him since he had meconium in the waters and she had never seen a spontaneous pneumo in her 30 years of doing home births. Not so. I have a video of Logan laying on my chest immediately after birth and you can tell he is really struggling to breathe and cry. And he didn’t actually aspirate any meconium. Had we been at home, it would have taken at least an hour to transfer to the hospital if the midwife attending was able to quickly determine that there was something wrong. By the time Logan was an hour old, he had been treated with an oxygen hood, chest xray, and diagnosed with the pneumo. It was, by far, one of the scariest nights of my life, but I am so incredibly grateful that we delivered in a hospital with a level 3 NICU.

After his birth, I found my passion. It took many months for me to accept it, but I knew pretty quickly that my career path was about to change. I toyed with the idea of what kind of midwife I wanted to be. I even considered home birth at one point but I never felt comfortable with the liabilities and risks. Even as I type this, I feel a lump in  my throat. My husband also expressed his concerns and thoughts and we have always had a deep understanding with each other that if one of us felt strongly about something, that we would respect each other’s thoughts and feelings on the subject. He’s a very easy-going guy and for him to feel strongly about my career path means the world to me.

Since then, I have busted my butt to really figure out what kind of midwife I want to be and what I believe. I know that there are good CPMs out there, just like I know there are good OBs and CNMs as well. This is not a post where I am going to knock CPMs and talk about how terrible they are and how home births should be outlawed. I’m not that close-minded or disrespectful. What I will say, though, is that I do not agree with the safety of home birth and how it is portrayed in the NCB. I think it feels like brainwashing and I can say that as I was one of those new mamas feeling the pull to make a rash decision without any education behind my choice to have a home birth (or not). I can say that I felt brainwashed into thinking that OBs were just surgeons looking for the big bucks and that they have no invested interest in their patients. In general, this is not true! I know and work with some incredible OBs, both male and female (not that that matters). I also know some OBs who I would not want to be under their knife, but isn’t that the case about any thing? You can have good lawyers and bad lawyers, good engineers and bad engineers, good OBs and bad OBs. 

There is a huge part of me that wants this to sound like I am a devil’s advocate, comfortable with either side of the debate of home birth vs hospital birth but the truth is, and what I believe, is that there IS a difference and that there are countless statistics showing how much safer hospital births are than home births. I am not going to list those here because most of us know how to use Google and other people have already gone the distance to do all that work. This blog is one of them. And here is another.

Long story short, I am not a fan of home births. I respect you if you’ve had one and if you are planning on having one, I hope you’re doing everything you can to learn about risks and complications for both mom and baby. Post partum hemorrhage, nuchal cord (around the neck), shoulder dystocia, meconium aspiration…just a few to name as complications that can happen even to a low risk healthy mom. Some of these become even greater risks if mom has other identifying factors, but they can still happen. I had a mom come in recently who had been laboring most of the day. She came in to be checked, was a 3, contractions kind of all over the place so she was sent home. She came in later that night when I was on and was a 6, but complaining of terrible pain in her stomach and baby heart tones were pretty low, despite position changes and even after contractions ended. Baby was not recovering and something was wrong.  We rushed her to the OR and it turns out her placenta was abrupting. Had we waited much longer both of them could have been in a world of trouble and had she been at home…I don’t even want to think about how badly that could have turned out.

I am constantly learning. The more I learn, the more I realize that home birth really is not a safe choice. It wasn’t for me, and for so many others it has ended in absolute tragedy. I have worked in the hospital for over 3 years and in that time, no babies or mothers have died due to something we were able to treat them for. Yes there have been hemorrhaging and codes and even an amniotic embolus in which both mom and baby survived!!

In closing, I would like to officially join the #notburiedtwice movement. I’m not going to go into detail about it here as I’d like to encourage you, dear readers, to find out for yourself. I am a firm believer in self-education and this is an opportunity for you to do just that.

Thank you for reading and allowing me the space to express these tough feelings. All I ask is that if you choose to comment, be respectful.