Midwifery Care & Homebirths

Hospitals aren’t the only avenue of care for pregnant women. Homebirths and midwifery care appear to be taking their respective place in the spotlight again. For centuries, midwives were the primary caregivers for pregnant and laboring women. In some countries, midwives are still the normal medium of care; the countries who have midwives as primary caregivers, on average have lower infant and maternal mortality rates and there is less medical intervention used, even in high risk deliveries.

According to David Stewart of NAPSAC News, the U.S. had an average infant mortality rate of nearly 9 deaths for each 1,000 live births in 1991. Delaware had 11.8 and Washington D.C. was even worse at 21 deaths for each 1,000 live births. Vermont had the lowest infant mortality rate of 5.8 as well as the highest rate of homebirths in the country. A larger portion of births are also midwife-attended in Vermont than most states.

“The superiority and safety of midwifery for most women no longer needs to be proven, it has been well established,” excerpt from The Future of Midwifery in the United States.
Although numerous midwife and homebirth studies have been conducted, medical organizations refuse to see the benefit of gentle birth and continue to use intervention practices. The Future of Midwifery in the United States boasts important facts that should be taken seriously; every study that has compared midwives and obstetricians has found better outcomes for midwives with same-risk patients. In some studies, midwives actually served higher risk populations than the physicians and still obtained lower mortalities and morbidities. With these studies available, it is baffling to see how many healthy women continue to believe the medical model is the safest form of care available.

Types of Midwives
Midwives offer a gentle birth choice and can be an option for you. Certain midwives may only attend a hospital or birthing center delivery and many others will attend a homebirths as well. There are three types of midwives you will find when looking; Certified Professional Midwife (CPM), Certified Nurse Midwife (CNM), and a Lay Midwife.

A Certified Professional Midwife is an independent practitioner who has met the standards for certification and is qualified to provide the Midwives Model of Care. Certification processes recognize multiple routes of entry into midwifery and includes verification of knowledge and skills and the successful completion of both a written examination and skills assessment. The CPM credential requires training in out-of-hospital settings.
A Certified Nurse Midwife is an individual educated in both practices of nursing and midwifery, and who possesses evidence of certification.

A Lay Midwife has entered the profession as an apprentice to a practicing midwife rather than attending a formal school program.

Finding a Midwife
Finding a midwife in a populous area is usually not difficult. You will typically have at least a few available to you. It can be more difficult in rural areas; but if you live within a reasonable distance to a metropolitan area, you should still have the same midwives available to you. Here’s where to look to find a midwife in your area:

• Look in the Yellow Pages under Midwife
• Call childbirth educators and other birth resources in your area
• Visit www.midwifesearch.com, an international directory of midwives and doulas
• Visit www.compleatmother.com/midwives/index.htm
• Visit Mothering Magazines Find Your Tribe discussion forum
• Call the Midwives Alliance of North America at (888) 923-6262
• Call the American College of Nurse-Midwives at (202) 728-9860

Interviewing a Midwife
It is important to interview several different midwives if you have them available to you. Good questions to ask are:

• What is your experience and training?
• How many births have you attended? How many of those were you the primary caregiver?
• What is your transport rate? This will tell you how comfortable he/she is with abnormal situations.
• How do I stay in contact with you?
• Do you have a limit on the amount of births you attend in one month?
• Do you have an assistant?
• What happens if two births occur at one time?
• Do you provide post-partum visits for mother and baby?
• Ask how they would handle any concerns you have. For example: What would you do if the cord was around the baby’s neck?
• Have you attended any VBAC’s (vaginal birth after caesarean)? What were the outcomes?
• What is your fee? Do you accept payments?*
• Do you accept insurance?

Midwifes are very approachable and among some of the most loving and gentle people. If you have the midwifery care available to you I highly recommend visiting with them to make your intimate moments of female care and childbirth more desirable.