Guest Writers, Home Birth Advocacy

A Physician’s Home Birth Presentation to the Board of Medicine

19 Comments 11 May 2011

a guest post by Madhavi

I had the honor of making a consumer presentation to the Pennsylvanian Board of Medicine on behalf of Certified Professional Midwives for their appeal for licensure in the Commonwealth of Pennsylvania. Currently, there are no laws, therefore no regulation, regarding CPMs in Pennsylvania. Access to a midwife CPM is the right of every woman who desires it. This was my presentation to the Board.

In February of this year, in attendance with my husband, I delivered a beautiful baby girl.

While obtaining care from an obstetrician and preparing to deliver in a hospital, we found that the journey to our baby’s delivery took some unexpected turns.

You see, as a board-certified and fellowship-trained physician, I had only been exposed to birth in a hospital setting. I did not realize that there was any other option. However, after much research, reading, and asking questions, at 34 weeks pregnant, we made the decision to have a home birth.

Of course, the number one goal for us was safety for me and my baby.

I wanted a natural birth, but we discovered that there is a terribly high cesarean rate in the US. The cesarean rate at many of the hospitals in the Philadelphia area alone is higher than 35%, yet the cesarean rate around the world is approximately 10%, partly due to the Midwife Model of Care.

A hospital is a good place to be if you are ill or if you need specialized care.

After all, it is the place where I have worked for over 15 years. But, pregnancy and birth are natural physiological events. All births do not need to be performed in the hospital.

So to my husband and I, the real question about safety was not, “Do we want to have a pleasant birth at home or safe birth in a hospital?” It was “Do we want to birth at home and run the very small risk of an emergency that might, but not necessarily, be handled better in a hospital, or do we wish to give birth in a hospital with its additional stress and the likelihood of an intervention?”

It became clear that birthing at home with certified professional midwives was the best choice for us.

We chose to have a home birth with certified professional midwives for other reasons too.

Among them were the certified professional midwife’s expertise and specialized training in working outside the hospital setting for birth, the thoroughness of care, the continuity of care, and the postpartum support for both me and my baby. As a health care provider, I make a conscious effort to provide exceptional care for my patients. Therefore, I am in a unique place to evaluate other providers as a health care consumer.

I continue to be impressed by the highest professional level of care that I have received from my midwives.

Each visit lasted an hour in face to face time of counseling. In each visit, my physical health was addressed in many facets. We went over nutrition, exercise, my psychological health and our preparedness for our baby’s arrival.

For continuity, I liked that the same health providers that cared for me during my pregnancy were going to be the same health providers that would be present during the delivery of my child -the same two midwives from beginning to end. There were no shift changes. We saw one of our two midwives at every visit.

After the birth of my daughter, the midwives did a home visit every other day and checked in by phone on the other days.

They followed us closely for six weeks, providing breastfeeding support and postpartum physical and psychological support. They did well-child visits for my baby. They were available to us on call at any hour. They answered questions every new parent has about her baby. In short, they provided the framework that is so important for the start of a new family.

Of course, we prepared for the upcoming birth in the visits as much as possible.

We asked what would happen in the event of an emergency. We saw the emergency equipment that the midwives brought to every birth, and were comforted by the knowledge that our midwives were prepared for transfer to the nearest hospital in case of any problem.

In the end, I gave birth in the comfort and safety of my own home, surrounded by people whom I love.

In this regard, our daughter was born in a loving place.

And I WAS much more comfortable at home. I was not flat on my back, feet in stirrups, attached to catheters, IV’s and monitors. I could walk around until it was time for the actual birth.

Lastly, by choosing homebirth, we were immediately part of a larger community.

This community consists of other women who have given birth at home. We are urban, educated women, as are our families. We are lawyers, physicians, teachers, engineers and artists. We want the very best for our babies and our families and in larger numbers each year, we are choosing certified professional midwives in our communities as our care providers for planned homebirths.

***********************************************************************************************

Madhavi Gupta is a mother and a board certified neurologist specializing in Headache Medicine. She and her husband, Jeremy, are advocates of hypnosis and affirmations for mindset shifts about birth, which you can read about at DyenFamily.com They even created a free hypnosis mp3 download available at Fear Free Birth

***********************************************************************************************

Your Comments

19 Comments so far

  1. Tanashia says:

    Awesome. Thx for sharing.

  2. April says:

    It is so refreshing to hear from a physician choosing homebirth. Thank you so much for sharing! I can’t wait to show this to my husband who is fearful of homebirth.

    • AnERPhysician says:

      Coming from a NEUROLOGIST. While still an MD, I would love to hear the same argument being made by a board-certified OB/Gyn. As an Emergency Medicine Physician, I am trained in managing emergencies in all fields. Having said that, I’m not fully prepared for all birthing emergencies (in a fully staffed emergency department). When home births go right, I’m all for it. However, how can you accurately predict emergencies that have no clinical signs or symptoms (with the basic equipment used for home births)? I feel much safer (for the morbidity of the mother and the child) if I have the ability to transport the patients to the delivery suite.

      Scary what they are trying to license people with. I pay for malpractice insurance (for when my roughly 40,000 hours of medical training), do they?

      • ~Kathy says:

        For the record, I’ve had three HBACs.

        The OB who backs up my midwife (board certified and FACOG) not only supports homebirth, he served on the state legislature and was instrumental in getting CPMs legalized in our state. Is that sufficient for you?

        Despite popular belief, there are very few true “emergency” issues that would necessitate and immediate c-section, and the odds of those happening are less than 1%.

        I’m honestly chuckling at your “basic equipment” comment. What do you think midwives show up with…incense, twinkly lights and a stethoscope? How do you feel about birth centers? Because my midwives carry around everything that a freestanding birth center would have, one benefit to me being I don’t have to leave my house in the middle of labor!

        Midwives are trained to be with each woman one-on-one throughout her labor and spot potential issues *before* they become emergencies. They transfer when something goes outside their scope of care or becomes worrisome…maternal fever, unreasuring heart tones, etc. That, in my opinion, is much better care than being in a hospital where one nurse might be monitoring three or more women, and the OB only shows up to catch.

        If you’ve only ever seen the rare complications, and not the majority that go just fine, I could totally see why you may have a skewed view of homebirth. I guarantee you that homebirth is not going away, so mainstream medical professionals would do well to accept that, and get out of the way so we can get an integrated and cohesive system in place.

  3. Julie says:

    Thank you for writing this! I hope PA is able to implement licensing standards for midwives hoping to obtain the same rights those in other states have.

  4. Terri says:

    My daughter is planning to have a certified nurse midwife attended home water birth utilazing the hypnobirth technique. We are VERY excited to be a part of such a meraculuous event utilizing the most natural methods available to her. Thank you for your informative personal story.

  5. Yael says:

    Thanks so much for this article. We need more physicians supporting homebirth, for the sake of the public, who need to be informed. Birth has been highly clinicized in Western society, to the point that women fear it. Like many other things, it has sadly become a business, feeding off of ignorance and fear.

    My two births were wonderful (birthing center, and homebirth), and I wish women the courage and guidance to make the informed choice to homebirth when they do not have a high risk pregnancy. Too many women are being cheated out of one of the most amazing experiences they could ever have. We’ve been pushed into the darkness, and every bit of light helps.

    Thank you!

  6. Jami says:

    i LOVE LOVE LOVE that a physician’s family gave birth at home!! it says leaps and bounds about the process!!
    I wish more women understood and weren’t afraid!!

  7. blessed5x says:

    I’m confused, please try to explain to me why it would benefit midwives and homebirthing mothers to have licencing and legislation. If there aren’t any laws on the books, isn’t that a good thing? Isn’t that freedom? I’m not trying to argue or debate, I genuinely don’t understand (as you can probubly tell). Can you help me understand?

    • Licensing laws exist to protect consumers so that they can be assured that their midwife is, in fact, a Certified Professional Midwife, certified by the North American Registry of Midwives. Without licensing, untrained persons can just decide to call themselves midwives, or midwives who lost the right to practice in another state because of incompetence could come to the unlicensed state to set up practice, and her new clients would never know.
      Also, most people don’t realize that, without licensing, CPMs are at risk of being arrested and charged with unauthorized practice of medicine. That’s because physicians ARE licensed and the way the laws are written for physicians, it makes it seem as if unlicensed midwives are trying to practice medicine. So, midwives need their own laws to define that midwives are ALSO permitted to attend women for prenatal care and giving birth. In many states (North Carolina and Indiana, most recently), midwives have been arrested and women who were being cared for them for prenatal care lost their midwives right in the middle of their pregnancies.
      Midwives are currently licensed or authorized to practice by state law in 27 states. In another 15 states, including PA, they have set up campaigns to win the right to practice legally. Check out http://www.pushformidwives.org/whatwedo for details on why and how you should work for licensed midwives in your state.

    • Licensing laws exist to protect consumers so that they can be assured that their midwife is, in fact, a Certified Professional Midwife, certified by the North American Registry of Midwives. Without licensing, untrained persons can just decide to call themselves midwives, or midwives who lost the right to practice in another state because of incompetence could come to the unlicensed state to set up practice, and her new clients would never know.
      Also, most people don’t realize that, without licensing, CPMs are at risk of being arrested and charged with unauthorized practice of medicine. That’s because physicians ARE licensed and the way the laws are written for physicians, it makes it seem as if unlicensed midwives are trying to practice medicine. So, midwives need their own laws to define that midwives are ALSO permitted to attend women for prenatal care and giving birth. In many states (North Carolina and Indiana, most recently), midwives have been arrested and women who were being cared for them for prenatal care lost their midwives right in the middle of their pregnancies.
      Midwives are currently licensed or authorized to practice by state law in 27 states. In another 15 states, including PA, they have set up campaigns to win the right to practice legally. Check out http://www.pushformidwives.org for details on why and how you should work for licensed midwives in your state.

      • ~Kathy says:

        Susan,

        While I agree with you in part that licensing makes it easier for consumers to know the qualifications of their midwives, I have experienced the issues that Loves Midwives speaks of.

        I had two HBACs in an illegal state with DEMs. We moved to a legal state, and despite having had two uncomplicated HBACs already, I had to get “permission” from an OB before my CPM could attend me at home. That idea is fine in theory, except for the fact there is only *one* OB in the entire lower half of the state who will approve HBACs, and he has to do it on the sly so he doesn’t get in trouble with his co-workers.

        If I weren’t lucky enough to know the midwife I did, who happened to have a working relationship with this single OB, I would have been *forced* to a) birth in the hospital, B) try to find an underground midwife who would potentially not be as qualified, or c) birth at home unassisted. We had to do a ridiculous amount of “sneaking around” to get to be able to do what we’d already done twice. It was stressful and annoying…two things a pregnant momma should not be.

    • Loves midwives says:

      Blessed 5x, Thank you for your comment. Legislation only puts rules out for the midwives to follow. No VBAC’s, no breech births, Water broke certain # of hours, etc.

      I agree with you to legislate midwives takes the “power” away from the parents & puts it into the governments hands. Parents are smart enough to protect their family & choose a safe midwife. There are very knowledgeable & safe unlicensed midwives out there!! There are also very dangerous licensed midwives out there!! But if parents do their homework they will find a safe one :)

      Again thank you for recognizing that to legislate and or license midwives is not in the parents best interest. Nor is in the best interest of our freedom!!

  8. Thank you for sharing your awesome journey with so many other people.

  9. Laura Walket says:

    Thank you for a perfect presentation of why home birth attended by certified professional midwives is optimal in the US. I chose home birth of my fourth child for all the right reasons as well, and was given so much grief by the ob/gyn and the pediatrician, both offices threatening legal action if I didn’t take my newborn to the ER the day she was born. I refused of course, never saw the ob again and changed pediatrician to one who supported birthing choices. But I live in Alabama where cpm’s are often prosecuted, so my cpm attended this birth by phone. I was attended by the father of my child and a friend who was an emt showed up shortly after the birth to verify all was well. I sure wish you could help us change the laws here. Thanks for sharing your beautiful story.

  10. Susanrachel says:

    Thank you for your frank and candid story. I am a homebirth midwife (though not a CPM) and am aware that PA midwives are in the midst of a legal struggle. Physicians like the one who commented above forget that we screen very carefully to reduce risk so that the likelihood of a healthy woman experiencing a healthy pregnancy has a VERY low chance of having an emergency we can’t handle at home and, as you said, we are educated and skilled at handling the rare unanticipated emergency. We stop hemorrhages the same way midwives in hospitals do. One in 100 babies needs resuscitation… which we do without the time delay that sometimes occurs in hospitals while waiting for peds to step in. We suture with lidocaine and sterile instruments. But you spoke to the midwifery model – which is what makes home birth with appropriate families safest of all – because at the center of care is RELATIONSHIP.
    One additional comment: Please consider changing your logo so the whole mother is there. In representing home birth, her face is more important than showing the house… and, if I’m going to give really picky feedback… the baby is posterior!
    Again, many thanks. And congratulations to your lovely family.


Trackbacks/Pingbacks

  1. A Physician’s Home Birth Presentation to the Board of Medicine « SmiffyBaby // Certified Organic Births - June 11, 2011

    [...] Click here to continue reading… [...]

  2. A Physicians Home Birth Story « Birthing in Hawai`i - July 5, 2011
  3. The Mamas’ Link Round-Up « Those Young Moms - June 18, 2012

    [...] A Physician’s Home Birth Presentation to the Board of Medicine – Bring Birth Home [...]

Share your view

Post a comment

Categories

Post Archives