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Advocacy: What Legalizing Home Birth Can Do For All of Us

This week I’ve been posting all about home birth.  What if it goes wrong (feel free to post your stories in the comments there!), an interview with a certified professional midwife, and even some statistics.  Today’s post, though, is all about advocacy: I believe we need to legalize home birth in all states.

Legalizing home birth is, truly, about two things: respecting the rights of women to make the right choices for their families, and making birth safer for all.  There are a number of things that cannot be accomplished in the current, rather hostile climate, especially in regards to CPMs.  Here’s a quick summary of benefits:

1) Legalizing home birth stops the process of criminalizing any birth attendants; making them more likely to quickly identify and transfer women in need without fear of prosecution (most do this anyway)

2) It allows for CPMs to have regulated training and certification programs, ensuring that all certified, licensed midwives are fully qualified

3) It allows CPMs and CNMs to work directly with one another and with OBs, ensuring that women who need extra care get it quickly, and have continuity of care (i.e. having met the back-up OB earlier in pregnancy, ideally).  All CPMs and CNMs would work with an OB directly.

4) More free-standing birth centers could be created, allowing women who do not want “the hospital experience” or to be at home to have a safe middle ground.  The hospital could be saved for women who really needed it or preferred to be there.  Currently most women do not have this option.  Birth centers allow women who want to labor naturally to do so, yet they are typically extremely close to hospitals and emergency equipment if needed.

5) There would be more respect for women and various birth choices, as well as all the different birth attendants and their varying roles.  We need all of them — CPMs, CNMs, and OBs — in different situations.

6) It may lead to fewer interventions being used when not medically necessary, since only the women who need help will be going through what is now the “standard” system.  If women had a “middle ground” option, more would likely choose it.

We need more respect for women and their choices.  And we need the circumstances that legalizing home birth — and CPMs — would provide!  CPMs who are well trained and properly licensed are suited to care for low-risk pregnant women, and can refer any high risk or questionable cases directly to OBs, who are more suited to handle them.  In countries where most women are cared for in this manner (and most give birth in birthing centers and are encouraged to be “natural” unless they prefer otherwise), neonatal mortality rates are low.  There is not such a polarization between doctors and midwives like there is here.

Currently there is such a disrespect between doctors and midwives — on both sides.  And there are some practicing midwives who are not well-trained or certified (though this seems to be the exception, rather than the rule).  In states where it’s illegal, though, there is no recourse.  Poor midwives can continue to practice and potentially hurt mothers and babies.  Since they are not required (and in some cases, not even permitted) to carry liability insurance, there’s nothing those mothers or babies can do.  Properly trained and licensed midwives, who can practice legally would be required to meet minimum standards and to carry insurance.

Some of you may be concerned that this is too much regulation for midwives.  But we need to be able to guarantee that birth attendants are qualified and safe.  Many currently are.  And many women carefully interview and select their birth attendants.  But it’s not so easy to find good ones in every area.  Legalizing and regulating CPMs would help women to have access to these qualified professionals.

Women will never agree on the “best” way to give birth, because there is no best way.  Women need a safe system and the freedom to choose the right for for them within that system.  As things stand now, this will never happen.  Women will continue to choose home birth, even in states where it is illegal, because they feel strongly about it.  A few will slip through the cracks of the broken system.  If you go back and read the comments on the first post, you’ll see some of those moms represented.

We need to work together, instead of fighting.  We need to advocate to make birth safer for all, and to give women the options that they want.  We need to use interventions where medically necessary — so that no women feel they must refuse to avoid a particular experience, and no women are told to take interventions for the doctor or hospital’s convenience.  We need to clear past the rhetoric and the basic differences in our ideology and understand that there is room for differences of opinion.

Do you believe we need an overhaul of our current system is needed?

Top image by mbaylor

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