Tuesday, September 18, 2007

An interesting question

I was asked this question today - "Laurel, why is it important that midwives who do not have medical training to be able to deliver a baby when you can have a midwife that does have a medical background?"

Here is my answer. I thought it was worth posting here"
For one thing, I cannot have a CNM ("a midwife that does have a medical background") attend my birth in my home. CNM's can only attend home births in Missouri (or get hospital delivery privileges) if they have a collaborative practice agreement with a doctor. Only 2 CNM's have been able to accomplish that feat in Missouri; neither of them live anywhere near me.

Secondly, while Certified Professional Midwives are not trained in the medical model of birth, the Midwives Model of Care in which they are trained is an excellent model. Their training is extensive, and is specifically focused on assisting women in home births. No other certification requires training and experience with home birth, so they are the logical choice for families who decide to have their babies at home. Additionally, study after study has shown that planned homebirth with a CPM is at least as "safe" as hospital birth, with fewer of the interventions that some families wish to avoid.

We personally have had a baby in a Missouri hospital with a CNM. We appreciated the services of our CNM, but it was obvious that the hospital environment was not the birth environment for us, except in the case that we needed medical assistance. That is why we have chosen to return to Kansas for subsequent births - to legally have the assistance of a CPM in a home environment.

Those of us who are striving to legalize CPMs in Missouri seek to not judge those who chose to birth differently than we do. We simply would like to see more healthy birth options available to the families in our state, and would like for parents to be affirmed in their responsibility and ability to make well-informed decisions on behalf of their children (instead of having their rights to make those decisions limited by the state). If that choice for someone else is to go to the hospital, that's a choice that I respect.


Williams' Family said...

What happens if there are problems? If they do not have medical training what happens then?

I ask because at the birth of our last baby his heart rate dropped and stayed down for along time. If the nurse would not have been monitoring him, we never would have known. They ended up having to use a vaccum to get him out quickly and as it was he was purple and not breathing great at all! Later my Dr. said that he really likes the idea of a home birth, but in this birth we would have lost him for sure! Is that just a chance you take? I am just curious!

Anonymous said...

Something I am personally curious about (and you can email me to answer, if you'd prefer)...growing up I never really recall us having conversations about family desires and birthing thoughts. Was this something you thought about, but we never discussed, or do I not remember it or was this all new discovery to you after we moved into the more "adult" stage of our lives? Just curious.

Laurel said...

That's a good question.

CPM's usually use doppler during labor to keep tabs on hearttones, and are trained in various ways to help get the baby out quickly. Changing positions can usually make a big difference, for instance. Midwives are trained in many techniques doctors don't use, both in the area of tracking what's going on and in assisting birth along.

Because midwives are trained to support normal birth, they are excellent both at heading off potential problems before they happen and at identifying problems in labor before there is a "minutes to act" crisis. Those are actually very rare in midwifery care, because of the way they are trained.

That said, yes, homebirth carries risks. So does hospital birth. While birth is a normal event that does not generally require medical intervention, things do sometimes go wrong. Babies die in hospitals at the same rate or higher as they die at home, research shows. So in many ways, it's a matter of which set of risks you're more willing to deal with.

Does that make sense? I hope it's some help. Feel free to ask more questions; it's one of my favorite topics. ;-)

Laurel said...

That's a good question, too, Tracy! :-)

It wasn't something I every really thought about before I got pregnant. Then, despite the fact that neither of us knew anyone who had had a home birth with a midwife, it just made sense to us. As the years have gone by, our research has only strengthed that perspective.

It's funny to me, though, that it's not something I'd ever thought about before getting pregnant.