Midwife Assisting Home Birth

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Midwife Assisting Home Birth

Photograph

By: Anonymous

Date: c. 2000

Source: Corbis Corporation

About the Photographer: This photograph is part of the collection of the Corbis Corporation, headquartered in Seattle, with a worldwide archive of over seventy million images.

INTRODUCTION

In the 1950s, most births occurred within the medical setting of the hospital. The rate of Cesarean sections (surgical birth) began to rise steadily, and medications for pain relief or even to induce amnesia were considered a normal part of the process. As the women's movement began to gain momentum in the 1960s and 1970s, interest in midwifery and home-births were rekindled as women began to challenge the obstetrical view that pregnancy was a sickness requiring medical procedures. Women began to assert that pregnancy and childbirth were a natural process. By the 1990s, some women began to choose to take the birthing process out of the hospital, out of the domain of the physician, and into birthing centers and homes. As a result, by 2002, the number of midwife-assisted births in the United States was over 328,000. Of those births, almost 14,500 of those births occurred outside of the medical community and in the private homes of the mothers. Many question the safety of home births, and in nine U.S. states, midwives who are not nurses and who assist in at home births can be arrested on felony charges. Supporters of hospital births suggest that lower infant and maternal mortality rates in recent decades are the result of medical intervention. Home birth practitioners, however, suggest that better prenatal care in the form of better nutrition, hygiene and disease control are the factors that have truly affected improved mortality rates.

Many cultures view home births as the norm. Traditionally, women, usually family members, have attended and assisted in the labor process. Home birth supporters assert that the creation of obstetrics relegated birth to the medical field. As women were limited in their ability to practice medicine, men became birth practitioners. As a result, childbirth became viewed as a medical procedure needing medical tech-niques and interventions. Women began to reassert themselves through the resurgence of midwifery.

The term midwife means "with woman" and there are several types of midwives: certified nurse midwife, certified professional midwife, direct-entry midwife, and lay midwife empirical. The certified nurse midwife (CNM) is a registered nurse who is educated in both nursing and midwifery. A CNM is also certified by the American College of Nurse-Midwives. Many CNMs perform home births with written collaboration with a physician. The certified professional midwife (CPM) has been educated either in schools or apprenticed. CPMs must pass a written and skills exam to be certified by the North American Registry of Midwives and work generally in birthing centers or at home births. Direct-entry midwives are considered independent practitioners who have been educated through self-study or apprenticeships. They may be educated through a school or university program, excluding nursing programs. The lay midwife empirical is an apprenticed midwife who chooses to not be certified. She is usually apprenticed under an experienced midwife and focuses on home births or birthing centers.

Those choosing home births cite a range of benefits, beginning with the extreme personal attention received from the midwife during the prenatal care. The at home birthing experience allows the mother to be in control. She can choose to move around her own environment or deliver in whatever position she deems to be most comfortable. The experience can be as public or private as the family chooses.

PRIMARY SOURCE

MIDWIFE ASSISTING HOME BIRTH

See primary source image.

SIGNIFICANCE

The medical community offers somewhat contradictory opinions on the safety of at home births. The Society of Obstetricians and Gynecologists of Canada supports the practice of midwifery but has stated, "The SOGC is opposed to home births because of the potential risks to the mother and fetus." However, a February 2002 study published in the Canadian Medical Association Journal asserted that home births are no more dangerous than those that occur at hospitals. The University of Copenhagen reviewed six studies surrounding 24,000 planned home births and hospital births. The review revealed that mortality rates were not significantly different between the two experiences. However, home births resulted in fewer maternal lacerations and less general medical intervention. The study also discovered fewer low Apgar scores, the testing to identify the activity, pulse, grimace, appearance and respiration of the newborn. Supporters of home births assert that the home birth experience also lessens the occurrences of infections acquired during and after childbirth, as the mother is not exposed to bacteria present in the hospital setting.

There are risks involved with at home births. A 1997 study released by Midwifery and Childbirth in America states, "The available evidence indicates that births attended by either midwives or physicians in homes and birth centers in this country can be as safe as in hospital births provided the following conditions…" Those conditions include a competent midwife, good prenatal care, more than one knowledgeable caregiver present at the birth, a clear criteria for determining high-risk pregnancy, rapid means of and transportation to the hospital in case of complications. The most common complications for at home births are maternal bleeding and fetal distress, or when the baby has difficulty receiving oxygen. All midwives are expected to be fully trained in infant CPR.