Reader comments
Home-delivery regulations for midwives may tighten

There seems to be an underlying attempt by organized "for profit" hospitals and care centers to cut in on the practice of midwives. Even the care and expertise given in hospitals is at risk for every patient and sometimes it is even more serious than not having treatment at these centers. A midwife provides a service at greatly reducded costs than what a hospital charges is why these laws and profession are being attacked. The hospitals are after these mothers giving birth for the money, not the kind of care a midwife provides. Childbirth happens regardless of wether a licensed doctor is there or not and even a doctor cannot predict the outcome in a multi-billion dollar hospital. It is more rare of complications from the services of a midwife than that of the incompetent services we get in a hospital. A midwife cares about the mother and child, the hospital is concerned about the bottom line and if the patients have insurance. Getting medical care in a hospital is too risky sometimes and too costly to for most americans, even with insurance.

Leave Midwife contributions alone. no regulations. this is an area where common sense must remain the driving forse. Not regulation.

You said it, Bob G! For years my wife and I have studied out the pros and cons of a homebirth vs a hospital birth. We never had any complications with our homebirth -- it was perfect. Let people choose for themselves whether or not they want a homebirth or hospital birth. From my experience, most people do not understand that a homebirth, even statistically speaking, is no more dangerous than a hospital birth. With the billions of dollars and years of tradition that are connected with hospitals, there will always be a stong push to opress midwives. Remember that pregnancy is not a sickness.

I've given birth to 8 children in a hospital, but only with the last did I find a midwife. But choosing a hospital was MY choice. Every woman should have the right to choose WHERE she gives birth and WHO delivers it. How much control should the government have over every day matters? This is going too far.

Just yesterday, February 7, 2008, my 2nd oldest daughter gave birth for the second time under the supervision of midwives at a birthing center. They did a more professional job, both times, than what I have witnessed at hospitals.

My wife has given birth to nine children, six of them at a hospital, and five of those "supposedly" under the supervision of an OB-Gyn. Two at home under the supervision of a midwife (the 2nd of those two with an apprentice in attendance). And the 9th at a hospital, under the supervision of only a midwife.

(Continued below)

"Our" experience has been, and proven, that though hospitals have more rescucitative equipment, and doctors with rescuscitative experience than midwives, that hospitals and OB-gyn's generally take many more risks than midwives do IN HOW THEY CARE or RATHER, DON'T CARE for birthing mothers.

On our 6th child born (5th w/an OB-Gyn) my wife had to wait five minutes for the OB-Gyn to arrive, even though he had had her "started", it was the middle of the day, and his office was in a bldg directly connected to the hospital.

The midwife who delivered our 7th & 8th babies did so at our home. She was there for hours before the birth, whereas the OB-Gyn typically only showed up minutes before the birth, and my wife was mostly under the care of nurses who though earnest and well-trained, were no where near as good as the midwives both my wife and a daughter have used.

It is much like the shuttle disasters. They were sloppy because they thought back-ups could rescue them. They were wrong! So are these people!

As a labor and delivery nurse for the past 18 years, I have seen my share of 'normal, healthy' pregnancies turn into disastrous labors with poor outcomes to the infant. Although these situations are statistically low, I personally would not want to be the the mother who had chosen to deliver her baby in a setting that did not have adequate manpower and equipment to properly care for her baby in an emergency setting. . . It seems that women who chose to deliver their babies at home set a higher priority on their personal comforts and control issues than they do on the ultimate safety of their babies. Midwives are a wonderful asset to the obstetrical community and a marvelous support to a laboring family. They should however be properly trained, practice within appropriate parameters, and deliver babies in an adequately staffed and supplied environment.

Amen momof6--my pregnancy was perfect but i would have died had i delivered at home. I found a fabulous midwife who has now helped us through 3 deliveries at St. Mark's birthing center. What if we had chosen home? My husband and son would be alone and i would be 6 feet under. It is a very personal choice, and there are enough health care providers in the SL area that you can find one that you like. If midwives all followed the guidelines for when to need help all would be well but i have heard horror stories of some who can't relinquish control. Safety first.

momof6, your comment is completely full of ignorance. Do you even know what kind of equipment a midwife brings to the home? Do you even know what kind of education and training a midwife must do before being licensed? You just assume that women who homebirth are selfish. And you just assume that based on a newspaper article that our numbers are horrible.

I chose a homebirth for the SAFETY of my child, not my person comfort. I've had two children in the hospital who often went into distress because they had a stressed out mom who was laboring on her back. Not good! I've had two homebirthed babies that thrive while laboring because I was relaxed and felt safe. Why do you think women would choose to labor in a place that feels threatening to them? I would be risk-out from this bill simply because I have always tested positive for Group B Strep(and before any of you freak out, it's not an STD, but a normal occuring bacteria that is VERY commom in women and is easily treated at home with antibiotics- which is in a midwife's practice scope).

Maybe more people should do their research.

If I could have my way I would birth at home... Instead due to more complications than I can count I have had to birth in hospitals. And I'm thankful they are there, because I wouldn't be alive without them. BUT the care you recieve is subpar (its sad when you a "mom" knows more about things than the staff taking care of you) At least with c-sections you see the dr. for more than a few minutes...LOL

To whom it may concern...we have had 3 hospital births, and 3 at home births. Unfortunately, "adequately staffed and supplied environment" does not ensure a great birthing experience, nor a safe one. I find it interesting that the "medical community" does not think the general population can make proper decisions on what they would like for the birth of their children. Are we not educated enough? I have found, from a father's point of view, that the "medical community" does not offer much in support to the birthing process, unless there is an emergency. We have found that hospitals like to "create" emergencies because of guidelines or, what I can only determine to be laziness or more concern for the doctors/hospitals schedule. For example, three times my wife was put on Pitocin (sp?) to force the birth because of blood pressure concerns (amazingly, those concerns were transparent at our home births). Most people do not know the dangers of Pitocin, but we are now educated through experience. High C-section rates are also the hallmark of Hospitals. I would prefer a midwife who cares more for the individual and less about the meat packing atmosphere of hospitals.

Momof6 your comments are typical of those involved in today's screwed up health care system. Having had 4 children with midwives and doctors. The level of attention to detail is so much higher with a midwife it is not even comparable. Doctors have made it nearly impossible to use a midwife and for one reason only - $$$. IMO you are more likely to have problems with your average Doctor than with your average midwife (at a hospital or not) - don't buy into the scare tactics...

Our first was a hospital birth (in it's new birthing center, even!) and was an unmitigated disaster, even by the standards of the staff. Three others at the Birth and Family place, and not a hitch in any of them. Future children, if we have them, we'd like to have the option of birthing at home, and we want a midwife to ensure that the best care is available.
Make it happen, legislators.

Studies have shown that home birth is safe as a hospital birth if three conditions are met: (1) low-risk pregnancy, (2) attended by a certified nurse midwife and (3) the ability to rapidly transfer the mother and baby to a hospital should complications ensue. It makes sense to limit the practice of midwives and home births to situations that fit these criteria. That means we need to carefully define what is considered low-risk.

I know of a women who chose a home birth for her 7th child. Unfortunately, the birth was complicated by shoulder dystocia. In a hospital, there would have been extra help around to speed the delivery process. However, in the home birth situation the baby spent too long in the birth canal and suffered brain damage. In retrospect, this woman probably did not meet the criteria for a low-risk pregnancy/delivery due to the large size of the baby.

Of course delivering in a hospital puts you at greater risk for a c-section, but that's another discussion entirely.

If we had known how much better having kids at home was, we would have had them all there. Comfortable, clean, relaxing surroundings, without all of the stress.

Hospitals are where you go when you want to be exposed to diseases you don't have at home (childbirth fever was one of these, only found in hospitals). It's so dengerous, they put acid in the baby's eyes to kill any stray STD germs from the baby in the next crib. Nurse, are you SURE you want to compare the "ultimate safety" of hospitals and homes?

You go to a hospital for high-risk births, or call Paramedics if something goes wrong at home, but fewer than 1/4 of the people alive today were born in hospitals, and those who weren't tend to be more healthy than those of us who were.

This is just a case of the medical industry getting the return on their campaign contributions to stifle competition.

Momof6, have you ever considered how many of these suddenly disastrous labors with poor outcomes turned disastrous because of interventions used at the hospital? Women who choose home birth do so because they feel it is safer for them and their babies, not because of the "experience". Statistics do, in fact, show lower morbidity rates for both mothers and babies in home births compared to hospital births. When a woman chooses to go to the hospital to birth her baby, she is subjected to lots of routine interventions which can interfere with normal, physiological birth. Often, doctors don't think twice about elective inductions, sometimes as early as 2 weeks before a woman's due date, and even elective cesareans are on the rise. All of these procedures increase risk to both mother and baby, yet since they take place at a hospital, and are performed by doctors, nobody bats an eye. They are acceptable choices. To say that women who choose to birth at home do so for their "personal comforts and control issues", and to imply that these women don't care about the safety of their babies, is both insulting and ignorant. Do your research before passing such judgment.

here seems to be a great deal of confusion about the intent and effect of Senate Bill 93.

First, the bill will only effect a tiny handful of the Utah midwives, specifically the Licensed Direct-Entry Midwives (LDEMs) who lobbied hard in 2005 for state licensure, but who now are resisting any attempt at actual regulation. The vast majority of practicing midwives are unlicensed and have no desire to seek the regulation that should be expected by a licensed caregiver. SB93 would have absolutely no effect on the unlicensed practice of midwifery. Nor would it effect the practices of the much better-trained Certified Nurse Midwives.

The intent of the bill is simply to better define when an LDEM should seek the assistance of those with additional training in dealing with potentially life-threatening emergencies. Currently, the law allows the LDEM to define for herself* what is a �normal� pregnancy or birth, which has allowed some to continue treating in situations where even an MD family practitioner delivering in a hospital would be required to seek an OB consult.

*I am not being sexist here. There are no male LDEMs in Utah.

(continued in next message)

SB93 won�t put anyone out of business, unless an LDEM only wants to attend complicated or high-risk pregnancies. Not likely.

Finally, there are a lot of people arguing that government should simply stay out of this realm altogether and let people practice due diligence in choosing a birthing provider and suffer the consequences if that due diligence is neglected. I would normally agree with the �Let the Buyer Beware� sentiment and to a great extent, that is how things work in Utah where the unlicensed practice of midwifery continues unencumbered. But when the life of a child is potentially at stake, the state does have a legitimate role in advocating for those who cannot advocate for themselves and protect those who cannot protect themselves. This is why abortion is regulated (some say too much, some say too little, but nearly all agree the state has a role).

Licensure adds the imprimature of sanction by the state, giving confidence to the public that the licensee meets and abides by standards designed to protect the public from harm. LDEMs sought hard for licensure. They should not balk now when the state tries to set reasonable standards for their practice.

"mother of 2" you are wrong about shoulder dystocia being handled better in a hospital. Doctors and nurses have no special tools or tricks for 'fixing' shoulder dystocia, they do exactly the same things as a midwife would do. There is no sure fire 'cure' for shoulder dystocia even in the hospital, it can't be predicted, and even small babies can experience it. In fact they probably have an advantage at home because the mother will be unmedicated and will be able to move more easily into a position that will get the baby out.

Yarstruuli, have you even read the bill? I don't think you have. Because of the broad restrictions in it, over 90% of the clientele of the small amount of midwives would be risked out. Keep in mind that less than 1% of Utah's population birth at home - so in reality that's about 34 women.

And the definition of "normal" in this bill describes a woman who is first time mother with impeccable health and no history of disease or genetic abnormalities. Come on! I do not know of a single woman who comes close to this definition.