Deseret News | Reader comments: Home-delivery regulations for midwives may tighten

Reader comments
Home-delivery regulations for midwives may tighten

Bob G | 4:29 a.m. Feb. 8, 2008

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.

Jayne | 6:35 a.m. Feb. 8, 2008

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

Homebirth Dad | 7:46 a.m. Feb. 8, 2008

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.

Comments continue below

Momof8 | 8:00 a.m. Feb. 8, 2008

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.

diligentdave | 8:17 a.m. Feb. 8, 2008

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.

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diligentdave | 8:30 a.m. Feb. 8, 2008

"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!

momof6 | 8:46 a.m. Feb. 8, 2008

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.

Lisa | 9:23 a.m. Feb. 8, 2008

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.

kameo1010 | 9:24 a.m. Feb. 8, 2008

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.

3 c-sections | 9:44 a.m. Feb. 8, 2008

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

Dad of 6 to be 7 | 9:52 a.m. Feb. 8, 2008

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 forget it | 9:52 a.m. Feb. 8, 2008

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...

Jeditoby | 9:53 a.m. Feb. 8, 2008

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.

mother of 2 | 9:58 a.m. Feb. 8, 2008

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.

4 at hospitals, 1 at home | 10:09 a.m. Feb. 8, 2008

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.

4kids8years | 10:13 a.m. Feb. 8, 2008

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.

Yarstruuli | 11:20 a.m. Feb. 8, 2008

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 ï¿½normalï¿½ 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.

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Yarstruuli | 11:21 a.m. Feb. 8, 2008

SB93 wonï¿½t 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 ï¿½Let the Buyer Bewareï¿½ 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.

the truth is out there | 11:34 a.m. Feb. 8, 2008

"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.

kameo1010 | 12:05 p.m. Feb. 8, 2008

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.

4kids8years | 12:10 p.m. Feb. 8, 2008

Yarstruuli, what are "reasonable standards", in your opinion? Being positive for Group B Strep is not a life threatening emergency, neither is having a history of babies weighing less than 5lbs. 8oz. or more than 9lbs. 14oz., or having had more than three miscarriages. Yet all of these women would be excluded from seeking care by a LDEM. Of course the bill would not have an effect on CNMs, since these midwives aren't eligible to attend home births in the State of UT to begin with. Yes, I do see value in defining what's normal and what's not. However, definitions of "normal" in SB 93 are entirely too strict, and would effectively put LDEMs out of practice. I think statistics for the last two years show that LDEMs do know their scope of practice, and transfer care to a physician/hospital when it becomes necessary. The simple fact that a midwife becomes licensed shows, in my opinion, a great amount of responsibility. It also shows that these midwives do care about the safety of the moms and babies whose births they attend.

kameo1010 | 12:13 p.m. Feb. 8, 2008

clarification on my numbers - appr. 30 women would only be able to use a LDEM.

What I don't get is that it is just a handful of us women who are choosing this option. Why pick on a small group of people?

And what I thought was more funny at yesterday's hearing was listening to the UMA's president openly admit that there is atleast one infant death per week at St. Mark's, what does that say about hospital numbers? Especially compared to our numbers since we've been granted licensure since 2005.

Attn: Kameo | 12:42 p.m. Feb. 8, 2008

"What I don't get is that it is just a handful of us women who are choosing this option. Why pick on a small group of people? "

It's not who many choose the option, it's that any at all choose it.

Marlene | 1:21 p.m. Feb. 8, 2008

people who fall through the cracks in our health care system have no choice but homebirth such people are oppressed enough I had one pregnancy where I tried unsuccessfully to get prenatal care I dutifully presented to hosp. in labor we have a healthy girl, but at what cost? I'm not convinced that she would have been any worse off if we had stayed home, we would surely be better off financially!yes, the sactrifice would have been worth it, but they didn't do anything "life saving" to her. That was 23 yrs ago, we will be in debt for the rest of our lives to pay those bills I have made the decision, I will never go to the hospital againIf I can help someone who is in this same situation I was, isn't that at least safer than leaving them by the wayside, with no care at all? Please do not restrict homebirth midwives! for some there is no choice!

Yarstruuli | 1:30 p.m. Feb. 8, 2008

Kameo & 4kids: It sounds to me that there is room for compromise between the factions as to the definition of a high-risk situation. If they would both stop being so rabid and unyielding and realize that there needs to be at least some regulation, but that it need not be so restrictive as to disallow the choice of an LDEM altogether, perhaps a compromise can be struck that will leave both sides grumbling, but keep them from continually returning to the legislature to browbeat our representatives to death.

I absolutely believe that the LDEMs care about their moms and babies. I also believe that the doctors are concerned with patient safety, not just the bottom line as some have suggested. Utah's obstetricians are plenty busy enough. 16 LDEMs are not going to make this a money issue, no matter how many babies they deliver.

Compromise is the answer to this debate.

4kids8years | 2:01 p.m. Feb. 8, 2008

Yarstruuli, the LDEMs and UMedA are actually working on coming to a compromise. The initial meeting was Thursday afternoon, and there is another one scheduled for Monday. It's going to be a painful process, for sure, and I'm certain both sides are going to have to "give" some. The problem with SB93 as it is currently worded is that it's overly restrictive, just as last year's attempt at regulation was. And from what I've heard from the Senate, legislators are getting tired of the run around - hence the stipulation that the LDEMs and UMedA reach a compromise before they will consider further legislation. What boggles my mind is that the UMedA actually had a chance to suggest regulations when licensure was first passed in 2005, but they never bothered to show up to the meetings...

Jane | 2:07 p.m. Feb. 8, 2008

It was only after a great deal of research and consideration of real evidence, not anecdotal incidents, that led me to stop having babies in the hospital and start having them at home. Interestingly, women who choose home birth are better educated, on average, than those who choose hospital birth. We are more likely to make informed decisions, rather than choose to accept what society says is best for us. Please don't assume things out of ignorance.

Jane | 2:30 p.m. Feb. 8, 2008

There is regulation of LDEMs and clarity about their scope of practice. The current statutes and rules that regulate LDEMs are all in compliance with the training they have received as Certified Professional Midwives (DEMs have to be a CPM in good standing to be licensed). The CPM certification is a nationally recognized certification which specifically addresses the unique circumstances surrounding home births and defines their scope of practice just like Certified Nurse Midwives' scope of practice is defined by their national organization.

Hospital1Homebirth2 | 4:57 p.m. Feb. 19, 2008

One's choice doesn't make another's choice wrong. It makes them different. Force comes from fear, not education. I wouldn't choose to birth in a hospital again, but I would never support a bill restricting others who want a hospital birth. A bill that restricts freedom is not for the benefit of others, it is coercion into conformity for profit.

The research is extensive. All the "stories" you may have heard are just that, stories. Hear it first hand from both sides, research both sides, and then choose. A 30 second soundbite or 45 minute newsmagazine episode or newspaper article do not experts make. Actual research and experience help.

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