More choose the comforts of home birth

Tracey Burkett is planning a homebirth for her second child, due in September.

And she is not alone.

The Centers for Disease Control National Health Statistics released a report last March that showed a five percent increase in the demand for out-of-hospital midwife births in 2005. In North Carolina, homebirths increased by 32 percent from 2003 to 2006.

For Burkett, the decision to use a midwife and give birth at home was a matter of wanting more of a voice in her pregnancy.

Pregnant with her first child, she knew she wanted to have a natural childbirth, but at 28 weeks, her doctor told her, "most women don't succeed with a natural childbirth."

Determined to be one of the successful mothers, Burkett switched to a Certified Nurse-Midwife (CNM), who worked in an office with an obstetrician. According to the American Pregnancy Association, a CNM is someone who is trained and licensed in both nursing and midwifery. Nurse-midwives have earned at least a bachelor's degree from an accredited institution of higher education, and are certified by the American College of Nurse Midwives.

With the help of her CNM, Burkett delivered a healthy baby girl through natural childbirth.

This time around, when Burkett found out she was pregnant, she had even more expectations for her pregnancy. Experienced in what the hospital would allow and not allow, she knew there were certain freedoms a homebirth could offer.

"Even though I was satisfied with my first birth experience, I know it will be more complete and comfortable in my own home. Any of my family can participate in the birth as much, or as little, as we want them to. I can do anything I choose, including eating while in labor, being in the labor tub, walking around, wearing what I want or have candles burning -- all things I had to fight to get in the hospital, because they were against hospital policy," Burkett said.

The one change, this time Burkett is using a Certified Professional Midwife (CPM). The CPM is a national certification recognized and licensed by 27 states, but is unlicensed in North Carolina. A CPM is someone trained in midwifery that meets practice standards of the North American Registry of Midwives.

"CPMs are not illegal. There is no law or regulation against them," Burkett said. "There is just no law licensing them. What this means for a CPM is they can be prosecuted for "practicing medicine without a license" or violating the Nurse Midwives Practice Act. Both are misdemeanors."

The North Carolina Midwifery Joint Committee (MJC) voted against licensure for certified professional midwives (CPMs) even though the North Carolina General Assembly asked them to propose a licensing framework to regulate CPMs.

"CPMs are the only professional healthcare providers who specialize in home birth," said Russ Fawcett, Legislative Co-Chair of the North Carolina Friends of Midwives (NCFOM). "Every year, more and more mothers in North Carolina are choosing to have their babies at home. Despite overwhelming scientific evidence presented to the MJC showing the proven safety of homebirth when attended by a trained midwife, the physician members on the panel chose to vote against providing a means to ensure that safety."

The MJC met over eight months, collecting data and testimony from midwives, physicians, epidemiologists and consumers. The panel was then presented a report of the findings.

The NCFOM believes the report shows the safety of homebirths attended by CPMs.

"Now more than ever it is crucial that North Carolina's home birthing families have access to trained midwives," Fawcett said. "Each year, more North Carolina families choose out-of-hospital birth for religious, cultural, philosophical or financial reasons. Home birth is happening whether or not North Carolina chooses to join Virginia, Tennessee, South Carolina and 23 other states in licensing CPMs. Why not do everything we can to regulate that practice and ensure safety?"

Currently, there are no laws in North Carolina to regulate CPMs, who deliver babies in private homes and freestanding birth centers.

NCFOM cites studies that show low-risk women who plan home births under the care of CPMs have outcomes equal to low-risk women who deliver in the hospital, but with far fewer costly and preventable interventions. They use a study commissioned by the Washington state legislature to show that during the last five years alone, Washington state's licensed midwives saved taxpayers and private insurers more than $10 million.

For Burkett, using a CPM has made her pregnancy more of what she imagined.

"I am not seeing a doctor, so my midwife performs all my prenatal care," Burkett said. " I see her once a month for pretty standard appointments, just like a pregnant woman sees an OB. She covers far more in our appointments than an OB has ever covered in the 10-minute appointments that I had at the beginning of my first pregnancy. My appointments with her last around an hour, and she is sure to answer any questions I could possibly have. I love the individualized attention I am getting with the midwife I am seeing. "

The majority of home birthing women do not see a doctor, according to Burkett. She feels there is no need, because a CPM is extremely qualified to monitor a pregnant woman and her baby's health.

"They spend far more time counseling a woman about her nutrition and health focusing on prevention instead of treatment," Burkett said. "If the CPM were to see something of concern, she would refer to an OB."

That seems to be the issue with no licensure. CPMs cannot transfer records and dialogue with an OB because of the risks of prosecution. The pregnant woman has to go in and try to relay the concerns from the midwife to the OB.

"There is always room for errors in communication in a situation like that," Burkett said.

At the end of the day, for Burkett, it's all about the family experience that will be shared in the birth of her new child that makes a homebirth the right choice.

"My daughter is very attached, and I want her to be a part of the birth, since this is her baby too," Burkett said.