• alison-cummins

    Here is the reason this matters: we are in the midst of a maternity care crisis. I’ve said it before, but I’ll say it again: our maternity care system is broken. Why? Because our maternal and fetal mortality rates are worse than 40 other countries worldwide, despite the fact that we spend more money than anyone else on maternity care. And where is  almost all that care being delivered? In hospitals.


    The only way this statistic could possibly be interpreted to show that homebirth and CPMs could be a solution to your abysmal maternal and fetal mortality rates is if those 40 other countries where women do better rely primarily on untrained midwives for maternity care.

    You have this information, right?

  • elliebeline

    Alison, if you read the entire article, which it appears you did not, I don’t think she wrote or proposed ANYWHERE that homebirths with CPMs was the solution to our poor rates. I believe she wrote that improving maternity care IN THE HOSPITAL is what we should focus on. And in a large portion of the countries that have better rates than us, those countries are attended my midwives trained not unlike CPMs, who happen to be integrated into the hospital system. Maybe if women weren’t treated so poorly in the hospitals presently, they would be less inclined toward homebirth. Clearly our system is not working in their favor. Get your facts straight, or at least read the article properly.

  • louana

    If a physician needed to refer a patient to a specialist for, say Diabetes, that physican would not have any problem doing so, since there is collaboration between physicians.  It would be terrible if a Diabetic patient could not get the care he/she needed because the Endocrinologist decided that the regular physician didn’t ‘deserve’ to make the referral.  If a surgeon was faced with a complication in the surgical suite, all he/she needs to do is make a quick call and a group of nurses and phsycians will come to help take care of the patient to ensure that the patient gets the best care possible.  It would be terrible if support staff would not help that surgeon because he/she didn’t ‘deserve’ the help.  

    If a midwife makes an appropriate transfer from the home setting to the hospital she and her client are treated like dirt.  Many hospital staff members actually defer appropriate care because the client chose to have a (read dirty) midwife take care of her.  This is an unacceptable situation.  Midwives are legal in most states in this country.  Out-of-hospital birth is legal in most states in this country.  Yet, physicians and hospitals will not collaborate with midwives to ensure the best outcome for women due to some notion that midwives are witches and that women who choose midwifery care deserve a bad outcome for their (legal) choice.  What is needed is not a debate over ‘is it safe?’ but it needs to be about how this health care profession can accsess referral care when needed.  I call all physicans and hospitals to step-up-to-the-plate and start making collaborative agreements with all midwives in this country.

  • kalacirya

     I’ll say it again: our maternity care system is broken. Why? Because our maternal and fetal mortality rates are worse than 40 other countries worldwide


    Two points:


    1) Maternal mortality rates: The USA has a higher risk pool of women than many other industrialized countries.  Take higher risk women with an often inadequate health care system, and you will see higher maternal morality.  This is not necessarily an indictment of the maternity care system in particular, as many of the risk factors are present before pregnancy.  I would say that the Amnesty report makes this clearer than this article.


    2)Fetal mortality: On the topic of birthing choices, perinatal mortality is the proper statistic.  Neither fetal nor infant mortality are an accurate reflection of maternity care.  Additionally, some of these statistics are especially not useful in an inter-country analysis.  While the American infant mortality rate might be a useful statistic to look at from year to year, in comparison to itself, it is not appropriate to use across nations.  In the USA, premature babies are considered live births and thus when those high risk babies died more often, they are captured in the infant mortality statistic.  Premature babies are NOT counted in many other industrialized country, making our numbers inflated in comparison.

  • farah-diaztello

    Out-of-hospital birth is legal in most states in this country.

    The laws and regulations governing midwifery vary from state to state, but there is no law in any state that forces a woman to go to a hospital or any other location to give birth. Therefore, homebirth is legal-in-fact for birthing women in every state, and any law that did purport to force women to give birth in a particular location would violate their human and constitutional rights. Whether it is accessible is another matter entirely, of course, especially taking into consideration your excellent point about continuity of care.  As long as women are not allowed to be arrested for the benefit of a fetus–which people are attempting to change in a number of states–home birth remains legal.

  • cozycoleman

    I often hear women use phrases like “They let me/didn’t let me” in regards to their births. Who’s birth is it anyway?

    Until the consumer demands evidence-based care, the hospitals will continue to practice daylight obstetrics, which is a large contribution to our current system’s dysfunction.

    The question is, how do you get the consumer to care enough to become informed prior to their first negative experience? Sadly, for some, that first negative expereince is their last experience on earth.

    Shows like TLC’s Birth Story are wonderful for indoctrinating expectant mothers into believing that they have no choice in their births. Normal, natural births are boring. They make bad drama.  Homebirths are downright dull… bring your knitting.

    And yes, birthing outside of hospital must be legal. You can always say it was precipitous. But some states still deny midwives licensing, which makes the choice to birth at home on in which the parents must either chose to go unattended or the brave crusading midwives must risk punative fines or arrest.



  • evidencebasedbirth

    I agree with the author. As  much as I think home birth could be improved (with regard to back-up care, CPM licensure, etc.), the focus should really be on the quality of care that is provided to 99% of American women during childbirth– in hospitals. As a nursing professor in the cardiovascular field, I am appalled by the lack of evidence-based care that is provided to pregnant women in hospitals. In my personal experience, I have seen no other medical field that shows such a blatant disregard for evidence-based practice.

    So, let’s DO something about it. Let’s join together on Labor Day, September 3, 2012, to rally nationwide for improved birth in our hospital systems. Every woman deserves to receive evidence-based care. Let’s fight for it together.

    Check out http://www.improvingbirth.org/national-rally-for-change/ to find if there is going to be a rally in your area. And if there isn’t, there’s still time for you to coordinate one in your town.

  • clementinemec

    Certified Professional Midwives are not “untrained”.  Indeed, they are the only kind of provider that is required to be trained specifically in out-of-hospital birth settings.  Doctors, and even Certified Nurse-Midwives are not even required to receive this kind of training, and yet they are legal providers of home-birth in all states.  Further, midwives trained strictly in midwifery, known as direct-entry midwifery, ARE the norm in most countries that included midwives as part of their maternity care system.  Entering midwifery by way of the nursing route first is considered by many of these midwives as irrevelant and rather a waste of time.  The CPM credential was originally created to be the CNM equivalent of core-competencies for entry-level non-nurse (direct-entry) midwifery in the United States, Canada, and Mexico. Not all CPMs practice in strictly homebirth settings.  Many run free-standing birthing centers, and even enjoy collaboration with their local hospital for transports, in areas where such a relationship is allowed to flourish.  

  • clementinemec

    Obstetricians do not practice evidence-based maternity care.  They practice litigation-based maternity care.  

  • cnm3789

    I agree that the question we should be asking is not whether home birth is safe but why isn’t hospital birth safer?  But let’s not further inflame the midwife wars by putting CPMs on one side and nurse-midwives with obstetricians on the other.  We are all midwives.  We all endorse and practice by the midwifery model of care.  We have more commonalities than differences.  Far better to work on fixing the system that restricts practice of qualified and licensed midwives whatever their backgrounds (just to cite one example) than set up these false dichotomies that glorify one group and trash another.

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