I just learned that June 6th is International Homebirth Day. I had no idea! I have warm, wonderful memories of my own homebirth with my second daughter, six years ago. But currently I have a heavy heart because of steps that have been taken against homebirth attendants in my state of North Carolina.
There are many other bloggers who have discussed the challenging status of homebirth in NC. Direct-entry or CPM's are not legally allowed to attend homebirths here, though in fact they do. CNM's are legally allowed to attend homebirths under the supervision of an MD. Recently, though, a local MD notified a handful of CNM's that he "supervised" that he would no longer be able to sign their licenses, and as a result those CNM's cannot attend births (unless they find another MD to supervise them, not an easy task.) I learned this information via social networks that I can't directly link to and blog posts like this one.
As I understand it, there are two issues that are important here: the licensing and regulation of Certified Professional Midwives, aka HB522/SB522 (being promoted by The North Carolina Friends of Midwives) and the requirement that MD's "supervise" CNM's attending homebirths (I do not know the details of this.) I did call NC Speaker of the House Thom Tillis that I supported the bill and want it to be heard and voted on!
Later this afternoon, I was shocked and saddened to see that the North Carolina OB/GYN society was seeking "bad outcome" homebirth stories. I had read some discussions, but someone was able to post a picture of the letter. After reading this, I decided to do something that is probably futile. I don't think my words will be heard or appreciated. But I decided to email my thoughts and personal story to the NC OB/GYN Society, just to be a positive voice. Since I'm pretty sure that my note to them (which had an error in it that I will correct below) will be deleted, I wanted to at least share it here for posterity.
To Whom it May Concern:
I recently became aware that the North Carolina Obstetrical and Gynecological Society is seeking information about tragic outcomes of homebirths. I understand that homebirth is not the typical birth experience in the US today, and that there have been some recent tragic outcomes that might be concerning to your organization, as they are to me. I believe that those isolated incidents are far from normal and in fact may be due to the hostile "climate" for homebirth in our state. Instead of taking efforts to restrict the ability of mothers who wish to give birth at home from having access to competent, trained midwives I believe that your organization should in fact be seeking to support the licensing of CPMs and increasing the ability of CNM's to attend homebirths. I am quite sure that you will still have plenty of "business"! (Ob-gyn's who attend hospital births.). My hope is that the current antagonistic relationship between the homebirth community and organizations such as this one can be improved. Please let me share my personal experience to explain why I feel this way.
I am a North Carolina native, but for eight years I lived in Ann Arbor, Michigan. Similar to NC, Michigan also does not license CPMs (though there is an on-going effort to change that), however the homebirth community is quite active there. I personally knew at least a dozen mothers who had homebirths with excellent outcomes. My first birth was in 2003 at the University of Michigan Hospital in Ann Arbor, and was attended by a family practice physician. I was induced at 42 weeks with cytotec (though I expressed concerns about the safety of this) and had a very, very challenging labor. I nearly ended up with a c-section, but after the 4th dose of cytotec my body finally went into labor, and then I struggled with contractions 2-3 minutes apart along with a premature urge to push. Once I was "allowed" to push, I was so exhausted that I fell asleep and they had to wake me up and tell me to push. My daughter was born well and healthy, which I was thankful for. The attending physicians were surprised when they saw my placenta, and described it as a "39 week placenta". There had been no medical reason for the induction, even though I did not want to have it, and it was considered an "elective induction".
I did not wish to repeat my first birth experience, which led to some breastfeeding challenges and great emotional distress on my part. My first choice, after I became pregnant with my second child, was to seek out CNM's who delivered in a local hospital. I quickly found out that once again they would "require" me to be induced if I went to 42 weeks, and given how my first birth went, I was not at peace with that. At this point, I sought out the homebirth community. I was pleased to find that there were a number of CPMs who practiced in the city where I lived. I met and interviewed several midwives, and ultimately chose a midwife who had been licensed in Tennessee, a state that has a significant history of midwifery and licenses these attendants. Even though she was not able to have a license in Michigan, her extensive training and background was important to me and my husband.
My homebirth experience was wonderful. Because our own home was very small, we traveled a short distance to my midwife's home and I was able to labor in her large tub. We had previously discussed my birth plan, what would constitute the need to transfer to a hospital, what actions she would take before birth (setting up oxygen, etc) and after birth. I had complete informed consent. I also had a doula who was present. My labor began when I was 42 weeks 5 days pregnant, and it progressed easily and there were no complications. My homebirth was notable because of the lack of drama and excitement. I went into labor, and supported by my midwife, husband and doula, gave birth to a healthy baby girl who weighed 8 lbs 2 oz, without any complications or issues.
My story is truly not unique. The search for bad homebirth outcomes by your organization is extremely concerning to me. Women have the right to chose where they want to give birth, and I believe that they should have the right to chose care providers/birth attendants who can pursue and obtain the best training possible for the role that they are in (i.e. Ob-gyn for high-risk births; Ob-gyn for your normal hospital birth; CNMs to attend births either in or out of the hospital; CPMs to attend homebirths or birth center births.) I truly believe that there is the need for all of these options to best serve the women of North Carolina.
I sincerely hope that your organization puts politics and personal preferences aside and looks at the facts. Some women in North Carolina will chose to have homebirths. Would your organization prefer them to have unregulated care providers, or attendants who are "out in the open" and accountable?
Like I said, I do not think that the above email will change anything. I'm not sure that my quick phone call changed anything. But I whole-heartedly support those working toward making positive changes to improve the legal status of homebirth attendants in North Carolina.
So that's my 2 cents on today, International Homebirth Day.
A picture of my homebirth baby with her dad...