I'm all for women being allowed to choose how they deliver, and I hope this legislation passes. I just can't understand why so many women want a midwife assisted birth. It seems risky to me. From what I understand, OB-GYNs are more equipped to deal with emergencies and pain relief.

The answer, though the article manages to completely gloss over it, is advocacy groups like the American College of Obstetricians and Gynecologists and the Missouri State Medical Association, which represent the interests of doctors. Not pregnant women and their families.

This is bad politically from a pro-choice point of view. If some wingnuts decide to push through a bizarre nonsensically worded abortion ban, then when the Medical Associations oppose it because it's medically nonsensical, there will be an immediate response of "but those medical associations hate women -- they backed a midwife ban, after all -- so people who don't hate women should support the ban".

Thanks so much for the links here. I just finished reading Born in the USA. It's remarkable to me how disrespectful to women this over-medicalized culture it--it tells us not to trust our bodies, and that childbirth is something wrong that needs fixed. I was amazed at how many of my liberal, pro-choice friends didn't understand midwifery, and let their support of "choice" end when a woman is carrying a wanted child.

Deja vu all over again.

When I was having kids in the 80s midwives were fighting for their rights to practice in California. They did pretty well.

In the 21st Century it seems that more and more women are turning their care over to doctors and not being that proactive about being in the driver's seat when they give birth (I know, I know but you can't be an active participant when you are drugged). The first comment in this thread kind of supports my point.

Anyhow, I am sad that the OB/GYNs and probably the Pediatricians are stirring up a hornets nest in Missouri and I hope the midwives prevail. I also hope that couples get back to taking a more active role in their own pregnancies and births. It really works better that way.

I read Pushed last month and even though I've had a longtime interest in home birth, it made me cry (literally, over lunch, in my school dining hall) I got so upset about the sheer amount of misinformation women are being fed about childbirth in the U.S. Pushed gives you a sense of the incredible work midwives and other advocates of women's health are doing to create a better standard of care--both inside and outside of hospital settings. I highly recommend it.

Ava, to speak to your question, Pushed, and the other book reviewed in Blustain's article (written by a World Health Organization doctor) both discuss the perception that midwife-assisted and home birth are "risky" . . . and provide statistics that show that to be pretty much untrue, except in some specific medical situations. Even those pregnancies dubbed "high risk" by the ob/gyn industry (multiples, vaginal-after-cesarean, etc) often have better results for women and infants when done in settings with the least amount of intervention (usually impossible in hospitals, with medical doctors trained to intervene as if every situation is a crisis). Midwives, in places where statistics can be kept, have really good track records for maternal and infant health--at least comparable to hospitals, and often higher.

From what I understand, OB-GYNs are more equipped to deal with emergencies and pain relief.

Yes, but they're also more prone to push for unnecessary medical interventions because birth is too often seen as a medical event. Epidurals, inductions, and C-sections are are just as risky as the possibility of a complication during a homebirth.

I don't know a lot about the subject of midwives, but I've read too many things about doctors and hospitals methods of dealing with childbirth to not be suspicious of how they handle it. First and foremost being the fact that for women giving birth in hospitals, the preferred position is on their back with their feet in stirrups, which is actually not a very good position to give birth in (squatting is better; gravity helps.) Why do they do it that way? Because it's easier on the doctor. That alone tells me whose comfort is given priority. Add to that various horror stories about how once the woman checks in to the hospital, any number of things can be done to her "for her own good" without her prior consent.

I'm all for giving women another option, particularly one that places the needs, comfort and interests of the woman and her child ahead of the of the person's who is aiding the delivery.

I had an *almost* homebirth with a midwife. My reasoning was that giving birth isn't a medical condition, so there was no need to go to a hospital where I would be treated like it was. In the end I had to go to the hospital for dehydration (I puked and puked during labor) and ended up doing a natural i.e. Vaginal delivery there. For my next child I will most definitely drink more water and have a home birth with a midwife. It floors me that the medical industry continues to treat women as though they aren't capable. As though having a child (the most natural thing a woman can do) is a sickness that ought to be left to the hands of the all might doctor. If anyone is interested, Spiritual Midwifery by Ina May Gaskin is a wonderful book that will let you in on why many women choose to birth at home.

I'm sorry, but I just have to comment, as I've had experience in this area, and it's not all about the high and mighty doctors. In reality, there are many states that have no type of certification or regulatory agency for midwives. Meaning that they don't even govern themselves to ensure that bad actors are not claiming to be midwives with no training, no experience and no clue what they are doing. I'm all for choice, and women should be able to choose the environment in which they give birth, and who might help them, but they should also have all the information. I'm not saying that women wouldn't research the midwife they choose, I'm saying there are someplaces where this information does not yet exist, and how can you make the best choice for yourself without all the relevant information? While some of these laws may at first glance seem bad, they may eventually be helpful in that they put more accurate information out there.

I would like to also point out that while these states have laws that prevent women having a home birth with the assistance of a midwife, it is not illegal in any state for a woman to have an unassisted birth. While some women choose unassisted home births for various reasons, some are choosing to just because they don't want to give birth in a hospital and yet do not have access to a midwife willing to do an at home birth because of the legal issue. Also I am not sure how popular this is around the country, but my local health care clinic where I got prenatal care all of the services there are done by trained midwives, not doctors unless the woman has a high risk pregnancy. A midwife, not a doctor preformed my delivery in the hospital. If a doctor is so much better then a midwife at delivering babies, then the medical community is putting uninsured women at risk by having their deliveries performed by midwives in a hospital. If both provide equal or about equal care, then having a midwife deliver a baby in an at home setting shouldn't be a legal issue.

I'm really not sure how making midwifery a felony is getting any information out there.

I take exception with the claim that it's the "all mighty doctor" who is at fault here. You want midwife births to be more common, FINE, but don't slander the medial professionals. Doctors are not trained to be slimy businessmen--they're trained to help people, and those that go into OB/GYN are probably not in it for the money given their astronomical malpractice insurance rates. Childbirths are very profitable for the hospital, so it is hospital administrators and hospital CEOs who have a vested interest in maximizing the number of births that occur there. This is yet another unfortunate consequence of for-profit medicine; if you look at foreign countries with socialized medicine (Denmark, for example), the majority of low-risk pregnancies take place at home or in birth clinics staffed by midwives.

Furthermore, doctors are not to blame for being extraordinarily cautious with regard to the birthing process. For that, you can blame those lawyers (such as John Edwards) who made fortunes by suing obstetricians for "causing" cerebral palsy by not monitoring the fetus/infant closely enough during birth. (Note that this has been categorically disproven--the vast majority of cerebral palsy brain damage occurs in utero, not during the perinatal period). The doctors are simply covering their own asses, as they are liable to lose their practice if sued.

“The doctors are simply covering their own asses, as they are liable to lose their practice if sued.�
Uh, what? When someone is having a homebirth with a midwife what does that have to do with the doctor’s ass?

The doctors are simply covering their own asses, as they are liable to lose their practice if sued.

Agreed. It's the fear of liability suits that has led more and more doctors to encourage elective C-sections.

I just got finished reading "For Her Own Good" and it's fascinating how the medical profession came in and usurped the birthing process from midwives and eventually women themselves, and in the beginning they caused more harm than good because birth was treated as a sickness and a medical condition.

I think if a woman wants a home birth good for her, and if there's a licensed midwife there to help all the better. Women don't have to give birth in hospitals, we were doing fine without them for quite a while. Having said that, it is nice to have a plan B ready, just in case something goes wrong because pregnancy can have unforeseen complications.

I don't know enough about the Missouri law, maybe the felony midwifery came into effect before the certification, or there are other circumstances surrounding it that aren't clear. Please don't misunderstand me, I'm not for making midwives felons. But there are currently states that have no criteria preventing someone from saying they are a midwife and starting a "practice". And I think those people give every midwife who has training, experience, certification, etc. a bad name. And I'm all for elimninating those people from the profession.

Weird timing, as I was just discussing this very issue with my class (Intro. to Gender Studies). At the heart of the midwifery vs. doctor-supervised birth issue is CONTROL. Choosing to work with a midwife and have a homebirth is seen as eccentric, even irresponsible, by many in Western society, and yet the vast majority of women in the world give birth without access to epidurals and other things considered essential here. A friend recently reported how her OB rolled her eyes and laughed at the idea that she (my friend) wanted to try and deliver her baby without pain medication, and I've heard lots of women report that their babies were "just too big" to be delivered vaginally. And yet the C-sections that are so common in the US and Canada are simply unavailable to women in other parts of the world, who seem to manage to reproduce anyway!

I personally had midwife-assisted births in hospital (an option in Canada), but there was lots of impatience from the hospital staff with my long labour and the nurses were very aggressive in offering drugs to regulate my contractions and speed things up.

Midwives (when they're recognized and regulated) are accredited professionals who are committed to taking more time to allow labour and delivery to progress naturally. In hospital settings, with shifts and high demand for beds and equipment, doctors don't usually have that luxury so there is pressure to hurry women along. I recall seeing a statistic a few years ago that one is 40% more likely to have a C-section if you come to hospital in labour on a weekend!

It's true that giving birth is dangerous, and maternal and infant mortality still exists -- even in expensive Western hospitals. But anxiety over loss of control means that midwives are objects of fear and suspicion, and medical boards are typically very reluctant to share power with them.

I just had my second child at home in a planned home birth with a midwife (and her apprentice) in attendance. I'm fortunate to live in a state (Oregon) where not only is it legal for midwives to attend home births, but they are licensed by the state, which gives them a level of credibility and support within the medical community. My first child was born in Kansas, where, while not illegal, midwives are forced to work outside the system. This makes a big difference in the kind and quality of care available to women seeking a home birth. My midwife here in Oregon could order any prenatal tests I needed, she could have administered IV fluids to me if, like Breeder, I'd become dehydrated, etc. Not true in Kansas. More access to high quality health care options, including widwife-attended home births, equals healthier women and babies.

badnfluence, it is doctors who are working hard to take this option away from women in Missouri, because it is ACOG, the American College of Obstetricians and Gynecologists, which led the charge to the courts. So laying the blame right on the doorstep of doctors is completely on point. They have the vested interest, they have the political clout, and they're using both to the detriment of women and their children.

ACOG is the organization whose standards and practices have given us our c-section rates which are between 2 and 5 times that recommended by the World Health Organization (depending on where you live, roughly 1/2 of the babies born in Washington, DC, for example, are via section) while our maternal and child mortality and morbidity statistics have worsened even as medical technology strides forward at a dizzying pace. (And especially if you're a woman of color or are poor.)

What ACOG says in their mission statements and press releases may come across as pro-woman. What ACOG delivers, time and time again? Falls far short of the mark.

And Awkward? There are organizations, primarily the North American Registry of Midwives, which provides certification for midwives who are not RNs. (Certified Professional Midwives, or CPMs.) They have standards for education, training and apprenticeship and ongoing requirements for men and women practicing in the field. Much as one can hire an accountant or a CPA, one can hire a midwife or CPM. Why shouldn't a consumer of a midwife's services be relied upon to make this call for herself?

Dreama, you and I are on the same page, please don't think I'm arguing with you. I agree the consumer should be able to choose. What I'm saying is, there are several states, including the one I am currently living in, where information is not readily available. Where people are able to say they have experience, have training, and have "documents" to back them up, when in reality they have nothing. Finding accurate information is difficult at best and detrimental in some cases.

I'm not arguing against midwives. I'm saying, there are many cases where there are no rules and regulations, and it is difficult to determine who the bad actors are. Because it is these bad actors, who can endanger the health of a woman and her child because they have no clue what they are doing. And supporting those individuals hurts the entire profession.

If you're looking for a state to make sense on women's health issues, Missouri is not it. I started medical school here in August, and during the first week, when all of the organizations and professional societies that students can join have recruiting, the lady giving the AMA/Missouri State Medical Association talk went on and on about how they successfully got the midwife ban reinstated.

That being said, I don't get the impression that most doctors I've encountered, or at least most younger doctors, are anti-midwife. These protectionist policies are the brainchildren of the medical bureaucracy.

I think midwives are important to have at home births, as they are trained not only to assist with delivery, but also to be able to recognize danger signs and to know if and when the woman needs to go to the hospital.

Can midwives give epidurals?

no midwives can't give epidurals, most people who have midwives are trying to avoid epidurals. I have had both hospital and home births, and have had one with an epidural and one without.

I loved my homebirth! My midwife and her assistants were extremely competent! My son was ten pounds and had his arm up over his head, they were able to help me get him out successfully, whereas if I had been in a hospital, it would have been a c-section birth.

The hospital birth...don't even get me started on how horrible that was!

I will NEVER give birth in a hospital again!

I live in Illinois where homebirth midwives are illegal (though we're working on that as well) and plan to have a homebirth when I actually bring a child to term (3 miscarriages in 9 months). The reason that midwives aren't licensed and regulated in states is because they're illegal. Women (like me, my MIL, about 20 other in my town that I know of, the Amish, etc.) will still use them despite this lack of regulation. Making them legal brings them under the jurisdiction of the state, which is something all midwifery advocates actually want.

My midwife is very experienced and went ot what is purportedly the best midwifery school in the country. She would be licensed and generally considered awesome in any of the states that do allow licensure, but since it's illegal here, she's underground. It sucks, it's not fair for her, and it's not fair for us.

One of the most problematic things about anti-midwifery legislation is the difficulty that arises when an "illegal" midwife is attending a home birth and something goes wrong with mother and baby that requires hospital transport. If the midwife is practicing illegally, she has no direct access to the hospital and must rely on community resources (i.e. EMS) She also can't identify herself as a midwife to hospital staff and is unable to provide a lot of information that could be valuble to the OBs caring for mother and baby. Illegalizing non-nurse midwives doesn't stop them from practicing, it just creates roadblocks for women to have control over their birth, and, when complications arise (as they do) it creates roadblocks to getting the care that they need.

That said, I believe nurse midwives (who have at least a bachelor of science in nursing and a masters in nurse midwifery) are legal in all states, but a lot practice in hospitals because few can afford the insurance for attending home births. Nurse midwives can prescribe epidurals in hospitals, though they also have advanced training in alternative pain management as part of the midwifery model of care, something OBs don't (many OBs simply consider epidurals to be the standard of care for pain management). In hospital settings, choosing a nurse midwife can help mothers avoid unnecessary intervention (usually their numbers are lower than the OBs).

In countries where midwifery is more widely utilized, the OBs stick to what they know, complicated pregnancy, labor and birth, the kind of births that require interventions. Otherwise they refer pregnancies to the midwives, who can refer back when a problem arises (placenta previa/acreta, preeclampsia, for some examples).

" If even uber-conservative Gov. Matt Blunt is in favor of decriminalizing midwife births, then who, you might ask, is against the legislation?"

I think this part of your post is misleading. Gov. Blunt is not in favor of this legislation (even if he did pass it). What's making this issue more complex is that most of the legislators voting on the bill had no idea that there was a midwifery amendment at all. This blog post does a pretty good job of recapping the situation:

http://www.doubletongued.org/index.php/grantbarrett/tocology_obfuscation_enhances_legislation/

It's very disappointing to hear the 'doctors are the safest option' argument coming out even on a feminist website. It's just basically not true - in New Zealand, 75% of births have a midwife as lead maternity carer, and in normal pregnancies, births under midwives are safer than OB births. They have lower rates of maternity and fetal mortality, lower episiotomy rates, and lower c-section rates. If you want an OB, by all means do so, but the argument that it's safer (for low risk/normal births has NO basis in truth, and arguing so simply leads to guilt on the part of women who believe that their own wellbeing is as important as that of their babies, and that they have a right to choose, where possible, a low-intervention birth. We need to get beyond the 'as long as the baby is healthy, it doesn't matter what interventions you have' mentality. All this does is reify the idea that fetal rights automatically outweigh a mother's rights. Please, can we research facts before we start fear-mongering? So much of womens' experience these days is tempered and controlled by fear. That's the last thing we should be promoting here.

I'm currently working my way towards being a midwife, so this issue is obviously near and dear to my heart. I'm always surprised to read the "doctors and hospitals are safer than midwives" argument, but that's just because I've read so much evidence to the contrary.

There are certain birth situations during which access to emergency equipment is a good idea. But those birth situations are much rarer than we are led to believe. A lot of this is due to media--whenever a birth is depicted on TV or in a movie, the mother is on her back, screaming and writhing with pain. Seeing so many births depicted this way leads women to believe that this is what birth has to be.

The problem isn't so much being in a hospital; it's the fact that setting foot in a hospital drastically increases a woman's likelihood of being subject to interventions she never wanted or planned for. The typical scenario goes like this (and I wish I were overreacting): denied food or water, a woman is placed on her back with a fetal monitor attached to her. She can't move comfortably because of the wires and such this entails. Since she can't move, squat, get on all fours, etc., her pain level increases and her labor slows. Faced with this pain and a lack of encouragement, she chooses an epidural. Numb from the waist down, her pushing becomes less effective or non-existent. She is then hooked up to a Pitocin drip to speed up her labor. The combination of pain medication and Pitocin make the baby's heart rate decelerate, especially during contractions. The woman is given a certain amount of time to progress before being told she must have a C-section. After the section, the baby is not breathing effectively because s/he did not have the "squeezing" motions of vaginal birth to clear her/his lungs. The baby is whisked away from its parents to be placed in an incubator with oxygem and possibly suctioned. The doctor is congratulated for saving the baby.

Any wonder so many people are opting for intervention-less births in birthing centers or their own homes?

Ava's question is an interesting one: Can midwives give epidurals?

The answer is no. Neither can OB-GYN doctors. Anesthesiologists give epidurals.

No offense, but I view that question as a red herring in the midwife v. OB debate.

Midwives (when they're recognized and regulated) are accredited professionals who are committed to taking more time to allow labour and delivery to progress naturally. In hospital settings, with shifts and high demand for beds and equipment, doctors don't usually have that luxury so there is pressure to hurry women along. I recall seeing a statistic a few years ago that one is 40% more likely to have a C-section if you come to hospital in labour on a weekend!

Again, the primary concern of doctors and hospitals regarding childbirth is for themselves, not the women. They're rarely willing to let nature take its course. An example: My sister-in-law recently had a baby. She intended to give birth vaginally with no drugs. Unfortunately, she went into labor late at night when the doctor wasn't available. Because it appeared likely she'd give birth in the middle of the night, they halted her contractions and told her they'd induce labor (with more drugs) in the morning when the doctor showed up. When the time came, the drugs they used to induce her caused such powerful and painful contractions that she ended up needing something for pain, too. Many hours and several unwanted "necessary" drug interventions later, they finally performed a C-section on her because she was just too exhausted to keep trying to deliver vaginally. What probably would have been an easy, uncomplicated birth ended up turning into a nightmare, just because she happened to go into labor at a time that was inconvenient for her doctor.

So yay for midwives and for having an alternative to that kind of bullshit.

Re: Epidurals. Nurse Midwives and OBs can prescribe them, but they call the anesthesiologist (or nurse anesthetist; as an RN, I like to credit nurses where credit is due) to actually put them in. But epidurals are just another option for pain control. They're certainly not the be-all end all and it's definitely possible, most of the time, to give birth without one (although lying flat on your back with monitors shoved up your vagina hooked up to a Pit drip doesn't exactly facilitate adequate pain management...no wonder more women are choosing to labor and birth at home).

There's some really shocking attitudes here.

It wasn't so long that Feministing promoted this conference to reduce maternal deaths in sub-Saharan Africa. One in six dying in Afghanistan and Sierra Leone from pregnancy or childbirth. To claim that pregnancy is not a "medical" situation is making a mockery of the huge advances in modern medical care which people receive. Just like vaccines, if it does its job properly people never notice.

Grumbelina: Do you know any good resources for learning about midwife-assisted hospital births in Canada? This sounds like an option I'd like to explore.

Ava, opting for care from a midwife instead of an OB GYN in not risky. I've experienced birth and prenatal care with both, and I would tell any woman to go to a midwife over an OB GYN. Giving birth in a hospital with doctors was a humiliating, mechanical, and traumatizing experience. You are more likely to experience complications or be coerced into a C Section with an OB GYN in a hospital. Midwives are pro-women, hospitals are pro efficiency. Midwives give you choices and lots of information to make those choices, hospitals tell you what you should do because they think you're too stupid to make a decision yourself. Western medicine has a disgusting history in regards to how it treats birth, and it hasn't gotten much better today. Hospitals in densely populated areas routinely force patients in labor to take pitocin or have c-sections simply because their birth process is "taking too long" without properly informing them about the risks. Despite all of this, this issue is more fundamental than that. It's about choice. Midwives are a safe, effective and pleasant alternatives and the state has NO RIGHT to tell a woman how to give birth. It's none of their damn business. I'll be damned if any patriarchy is going to tell me that it's better to give birth in a cold, mechanical, impersonal hospital where I'm at higher risk for infection and traumatic stress surrounded by people who are more concerned with efficiency than with providing me with a positive birth experience than in my home with people I trust.

Yes, many women and infants die needlessly in second- and third-world countries because of lack of medical care. But the things they die from are infection (caused by dirty tools, lack of handwashing, etc.), dehydration, poor nutrition, lack of prenatal care, etc. are all things a pregnant woman will get from a midwife (in fact, studies have shown that a woman who sees a midwife, whether she plans to give birth at home, in a birth center, or in a hospital, will have significantly more face-to-face time with her care provider than a woman who goes with an OB-GYN). Most of them are not dying from lack of Pitocin and a C-section.

It's telling that the United States has one of the highest rates of birth intervention among industrialized nations and also has one of the highest rates of complications and maternal deaths among those countries. If doctors and hospitals kept women safe, we wouldn't rank so low in terms of maternal and infant health.

I agree with most of the comments here about positive midwives versus ACOG's attempt to limit women's choices.

I do have a couple of nitpicks, however.

And yet the C-sections that are so common in the US and Canada are simply unavailable to women in other parts of the world, who seem to manage to reproduce anyway!

At the same time, maternal and infant mortality is much lower in the US and Canada than it is in other parts of the world. I do agree that OBs perform too many c-sections here in the US and Canada. I also agree that the high c-section rate has more to do with protection from malpractice suits than the preservation of the woman or the fetus/neonate. I will also acknowledge that the lower maternal/infant mortality rate is most likely the result of better (or existent) prenatal care. Nevertheless, in the case of a high-risk pregnancy, a c-section can literally be a life saver.

[I]n New Zealand, 75% of births have a midwife as lead maternity carer, and in normal pregnancies, births under midwives are safer than OB births. They have lower rates of maternity and fetal mortality, lower episiotomy rates, and lower c-section rates.

How much of that statistic is the result of self-selection? Women who know they are at high risk are probably more likely to go to an OBGYN instead of a midwife because they know that they need more medical intervention. If that is true, then the pregnancies that OBGYNs deal with are *already* more likely to end in c-sections, damage, or death.

Neither of those two nitpicks negate the original post. As skeptical as I am of them personally, I have nothing against allowing home births for those who want them. Women need choices. It's appalling that ACOG is working to limit those choices. The real shame is that our choice do not have to be "either/or". In this state, midwives and OBs often work together. We even have hospitals with special birthing rooms. The midwives can do their thing, but they are RIGHT THERE in the hospital, with doctors right next door, in case something goes wrong.

I agree with most of the comments here about positive midwives versus ACOG's attempt to limit women's choices.

I do have a couple of nitpicks, however.

And yet the C-sections that are so common in the US and Canada are simply unavailable to women in other parts of the world, who seem to manage to reproduce anyway!

At the same time, maternal and infant mortality is much lower in the US and Canada than it is in other parts of the world. I do agree that OBs perform too many c-sections here in the US and Canada. I also agree that the high c-section rate has more to do with protection from malpractice suits than the preservation of the woman or the fetus/neonate. I will also acknowledge that the lower maternal/infant mortality rate is most likely the result of better (or existent) prenatal care. Nevertheless, in the case of a high-risk pregnancy, a c-section can literally be a life saver.

[I]n New Zealand, 75% of births have a midwife as lead maternity carer, and in normal pregnancies, births under midwives are safer than OB births. They have lower rates of maternity and fetal mortality, lower episiotomy rates, and lower c-section rates.

How much of that statistic is the result of self-selection? Women who know they are at high risk are probably more likely to go to an OBGYN instead of a midwife because they know that they need more medical intervention. If that is true, then the pregnancies that OBGYNs deal with are *already* more likely to end in c-sections, damage, or death.

Neither of those two nitpicks negate the original post. As skeptical as I am of them personally, I have nothing against allowing home births for those who want them. Women need choices. It's appalling that ACOG is working to limit those choices. The real shame is that our choice do not have to be "either/or". In this state, midwives and OBs often work together. We even have hospitals with special birthing rooms. The midwives can do their thing, but they are RIGHT THERE in the hospital, with doctors right next door, in case something goes wrong.

Awkward, if a midwife is credentialed by NARM, then they are being held to the highest standards -- higher (at least at the time that I researched becoming a CPM, something I chose not to do because my state refuses to acknowledge non nurse-midwives and bad legal precedents are being made against them) than any state requires of those who practice in the field. If someone is waving about "documents" to attest to their qualifications, a woman has every right to investigate what those documents say. If they aren't from NARM and the midwife isn't a CPM, then it's up to a woman to decide whether she values whatever those documents are. To say that the state must step in with licensing and putting their imprimatur on midwives for the protection of women devalues our ability to make those choices for ourselves, and imbues the state with far too much power, not to mention, because their requirements are never as stringent (for any health-related profession) as the focused private groups that give credentials, falsely assumes a level of quality will come with state approvals which almost certainly will not.

In New Zealand, 75% of births have a midwife as lead maternity carer, and in normal pregnancies, births under midwives are safer than OB births. They have lower rates of maternity and fetal mortality, lower episiotomy rates, and lower c-section rates.

How much of that statistic is the result of self-selection? Women who know they are at high risk are probably more likely to go to an OBGYN instead of a midwife because they know that they need more medical intervention. If that is true, then the pregnancies that OBGYNs deal with are *already* more likely to end in c-sections, damage, or death.

That's why I used 'normal and low-risk' - for ALL pregnancies which are normal and low risk, the birth rates are better under midwives than under OBs according to the WHO. In NZ it is not exactly self-selecting, as almost all women start pregnancy care under a midwife, unless they choose to pay large amounts for private care to begin with (pregnancy and birth are paid for by public health here unless you choose to go to a specialist with no medical reason). Women are sent to an OB by their midwife if it is medically required.

Almost everywhere in the developed world, low risk births under an OB have a higher risk of intervention and subsequent complications (severe haemorrage in particular) than low risk births under a midwife, and in several Scandinavian countries, they have both the highest rates of homebirth in the developed world (I believe I've heard in the region of 70% in Holland, though I may well be wrong) and some of the lowest c-section rates, which should tell us something about the fear-mongering in US, Australia, and to a lesser extent, New Zealand (where despite the high midwife birth %, 95% of births are still in hospitals).

maternal and infant mortality is much lower in the US and Canada than it is in other parts of the world.

Actually, infant mortality is pretty bad in the US. The last stats I read put us at #37 worldwide, two notches below Cuba.

d'apostrophe: midwifery is regulated differently in each province, so where you are dictates what you have access to. This site has the most up to date links to midwifery associations in all provinces: http://www.midwiferytoday.com/international/canada.asp

Good luck!

maatnofret: others have posted stats on maternal and infant mortality rates in the US and other industrialized countries, and Jessica F. right ahead of your post gives an explanation as to why mortality rates are higher in developing countries. LIcensed midwives in industrialized countries like the US, UK and Canada adhere to high standards of hygiene and care.

Emergency caesarians do indeed save lives -- I was born this way myself, as was my mother!

Choosing to work with a midwife and have a homebirth is seen as eccentric, even irresponsible, by many in Western society, and yet the vast majority of women in the world give birth without access to epidurals and other things considered essential here.

This is completely untrue. First of all, in Europe, midwifery is routine. The standard of care in many European countries is that normal pregnancy is handled by a midwife (a European midwife is approximately equivalent to a certified midwife or CNM in the US, depending on whether they underwent nursing training first or not). In the Netherlands, 30% of births are midwife-attended homebirths (and the CS rate is about 15%).

However, there are some very big differences. There is only one class of midwife, no division between CNMs and DEMs. All are required to be legally regulated. And they operate under strictures that many American homebirth advocates would find overly restrictive. In the Netherlands, a midwife may not attend a VBAC. It must be done with an OB in a hospital. (Officially the UK is the same, but because of the NHS "duty of care", if you refuse to attend hospital they have to send a midwife.) Other exclusions for midwifery care include multiple births, breech, and my favourite (and the stupidest of the lot), "high BMI". (I gave birth on the NHS.)

I actually do have issues with the two-tier system of midwifery in operation today in many US states. The midwifery schools that many DEMs go to simply don't provide the level of education that a CNM has. In some states, the requirements for midwifery practice are very low.

US death rates depend on what you measure. The perinatal mortality rate is very low. The neonatal mortality rate is higher. And the maternal death rate is high (relatively speaking).

I find the tone of many NCB/homebirth advocates and sites worrying, because I've seen too much advocacy of things that are risky in the name of "choice". I've also seen too much black and white stereotyping of the Evil Medical Profession versus the Heroic Midwife. Guess what--I had some obnoxious, stupid midwives in hospital, a great OB, and a very necessary Caesarean section (I would prefer not to repeat the experience, but it was the right one at the time). I also know a woman who suffered terribly because her hospital, in its infinite wisdom, had decided that only Caesarean births could have epidural anaesthesia. In order to get one she would have had to go to a hospital an hour away.

Finally, the "other places" argument is nonsense, because many of those places that don't have all these things have a lot of dead and injured babies and women. Technology is useful. it's its overuse that is a problem.

I am so thrilled to see this issue addressed on Feministing. Whoever said this issue is about control is absolutely right. I birthed my three youngest children at home (after 2 hospital births) because of my refusal to give over control of my body, my baby and my future to the hospital machine.

My homeborn babies were all least ten pounds. (One was only 2 ounces shy of 12 pounds.) Yet they were all born naturally without anyone slicing my woman parts or my abdomen. My homebirths were awesome, powerful, amazing, AND much safer than subjecting myself and a newborn to staph infections, medical mistakes and harmful hospital routines.

"What about emergencies?" That's why I wanted homebirths! With homebirth, there most likely won't be any emergencies since the birth is not being rushed and meddled with using drugs that are not even approved for pregnant women. At home I am relaxed, thrilled, excited, I am the boss, and everyone answers to me.

When emergencies do happen, good midwives are well equipped to deal wtih them. We did have a couple of emergencies, and I was so glad to have an experienced midwife rather than a medico when they happened. Two of my babies got stuck at the shoulders(shoulder dystocia) on the way out. If I had been at the hospital I likely have been subjected to a "vaginal c-section" to remove these enormous babies. Sometimes doctors even force the babies back into the birth canal and perform a c-section, a procedure that frequently results in infant death.

The wise woman attending me knew exactly what to do. She had those babies out within less than a minute using a position and technique developed by Ina May Gaskin.

FWIW, the Gaskin Maneuver is the first "obstectrical procedure" to be named after a midwife. And she actually learned it from wise aboriginal women (I forget where.) How cool is that? Birth is a woman thing, after all.

I laughed when I saw a sign at my OB's office that said, "Our obstetricians no longer perform vaginal birth after caesarean." I laughed because all the doctors in that practice are male. How could they possibly perform a vaginal birth without a vagina?

But after I laughed, I cried. What right do doctors have to refuse a procedure that is SAFER for the woman and baby? What right do they have to force women to undergo unnecessary surgery? Yet they do, and women have even been forced to comply with unwanted c-sections to avoid arrest.

This is one aspect of "a woman's right to choose" that often gets lost in the shuffle.

As mentioned above, this issue for me comes down to two things: certification and control. Certification is the much smaller of the two, if midwives are to be used extensively then they all must be certified but I'm sure that is in place or will be in place.

The control part, for me, is tricky. If, overall, it is better for the child to be born in a hospital, then in the interest of the welfare of the child should not the child be born in a hospital? Is the act of birth the exact moment when the mother loses some of her total control over the child? I do not pretend to know the answer but it seems to me if, overall, it is better for the child to be born in a hospital if possible, would it not be the mothers responsibility to make sure that happens?

On the flip side, if its a low-risk pregnancy, a midwife is present and adequate facilities are provided, shouldnt the mother have the choice where to go through this process?

Does the child itself have a right to the best possible environment in which to be born, superceeding the wants of the mother?

Will be interesting to see how this plays out.

dananddanica: If, overall, it is better for the child to be born in a hospital... Does the child itself have a right to the best possible environment in which to be born, superceeding the wants of the mother?

I'm a certified birth doula; I've attended over a dozen births, including one homebirth last May.

My answer is this: That argument is not valid (I know it was just hypothetical for you, just answering it anyways), because hospital interventions cause complications for both the mother and the baby. This doesn't mean complications don't happen spontaneously in natural births, its just that interventions make it far more likely. I've seen it first-hand. What is safest for the mother is safest for the baby. IVs, denying women food in labor, fetal monitors which strap women to bed, pushing with all their might on their backs, episiotomies, c-sections, etc., are not safe for women unless there is a medical reason for them. But hospitals apply these things to ALL women, regardless of risk for their own convenience. These routine interventions make birth riskier for the baby.

A woman who is giving birth at home without these interventions (i.e., she is free to move around, isn't medicated, etc.) is more lilely to have a normal, healthy vaginal birth. Normal births are safest for babies. The medical literature has been telling us this for decades. You cannot separate this into two issues and pit the mother's needs against child's. This isn't about the mother's homey experience versus the baby's safety. Their needs are one.

I'm a student in Missouri and I work as a reporter. I wrote a story about this earlier in the year and am sad to see that midwives are still seen as felons here.

The midwives have to be very trained and have the same knowledge as doctors. If only medical facilities would choose women's health and safety over money, we could all choose how we want our babies from our wombs delivered!

My partner and I chose to have a midwife attend the birth at the birthing center. She is due in February. I would agree with most of the arguments here in favor of midwives, and would say that it is about control. It surprises me that people would argue against midwifery, but I guess the medical profession has inserted itself into the lives of women so well that they are thought to be the way, as opposed to a way.

I hope this legislation passes. Our midwives have been absolutely wonderful and encourage anyone to consider a midwife.

"'Choosing to work with a midwife and have a homebirth is seen as eccentric, even irresponsible, by many in Western society, and yet the vast majority of women in the world give birth without access to epidurals and other things considered essential here.'

"This is completely untrue. First of all, in Europe, midwifery is routine. The standard of care in many European countries is that normal pregnancy is handled by a midwife (a European midwife is approximately equivalent to a certified midwife or CNM in the US, depending on whether they underwent nursing training first or not). In the Netherlands, 30% of births are midwife-attended homebirths (and the CS rate is about 15%)."

Good point. Maybe part of the disagreement is just what "Western" means and whether it can include the further-west parts of continental Europe/Eurasia?

"Finally, the 'other places' argument is nonsense, because many of those places that don't have all these things have a lot of dead and injured babies and women."

Another good point.

I'm now reminded of the cultural relativism over in another thread. If a woman's or girl's heart and brain shut down several hours after she manages to reproduce, does whether she's dead depend on how culturally authentic her circumstances were?

"Technology is useful. it's its overuse that is a problem."

For example, some waterbirths need shark-proof pools but shark-proofing every birthing pool would be overusing that tech.

The other day I saw this after wondering why some aquariums discourage people from doing meet-the-dolphins programs during pregnancy:

http://www.gentlebirthmethod.com/press/press_water_kindred_sp.html

"...Six pregnant women, a medical team and massage therapists flew out to the resort of Eilat to give birth with dolphins in the Red Sea helping women to have a tranquil labour.

"The trip was meticulously planned, with Dr Motha, an anaesthetist and another obstetrician in attendance. A shark-proof, glass-bottomed birthing pool was specially built, with the seawater filtered and heated to body temperature to make it safe and hygienic to give birth in..."

Seems like another interesting option. I wonder what the dolphins involved think of it.

I can't help but imagine that they're thinking some version of "What the fuck? You've had us doing somersaults for fish, delivering your bombs, and saving you from sharks--now we have to help you give birth, too? Can't you people do anything by yourselves? And what do we get out of all this? Oh, another dead fish. Fabulous."

"I can't help but imagine that they're thinking some version of 'What the fuck? You've had us doing somersaults for fish, delivering your bombs, and saving you from sharks--now we have to help you give birth, too? Can't you people do anything by yourselves? And what do we get out of all this? Oh, another dead fish. Fabulous.'"

Heh. :)

Fortunately, in Dr. Motha's case the women chose to go to the dolphins instead of the dolphins getting captured and trucked in tanks to the women.

According to the article, "The location needs to be somewhere with warm seas where dolphins swim regularly." OTOH it didn't say if the dolphin watchers (well-wishers? curious? gawkers?) were given anything for paying attention instead of continuing to do their thing in the rest of the Dolphin Reef sanctuary.

I think it's interesting how a lot of people are speaking about the extensive amounts of intervention that hospitals force on women during birth. I understand that that's the norm, but when my mother was in labor with me for 36 hours, they specifically told her that they did NOT want to do a C-section. As it turned out, they should have, and the birth ended up being far more complicated than it should have been.

Knowing how difficult my mother's labor was with her first child, it makes me wonder what I should choose for when I have my own children. I'd prefer to use a birthing center or home birth situation, since the risk of infection is lower and all the other reasons elucidated here. However, knowing that I could have a high-risk delivery makes me think that I should be in a hospital setting. Luckily, it should be a few years I have to decide this.

I am in favor of women having the right to deliver their babies however they wish, with whatever assistance they wish.

However, it is unfair to OB's to say they only care about themselves and not their patients. In my experience, that is simply not true.

As a lawyer I have defended midwives, nurse-midwives and OB's in malpractice suits. In all of my cases the pregnancies were supposedly normal, not high-risk, but during labor something went wrong and the child ended up injured or dead. To me it's frightening how fast complications can occur during "normal" labor and delivery. I would advise having someone available to assist with the highest amount of training and the best emergency equipment a room away rather than having a home delivery.

It's a choice, SL, and people may minimize the risks they themselves face. On YouTube, I can see videos of women knowingly giving birth at home, completely unassisted. A tragedy for mother or child could occur so easily.

as a soon to be OB-GYN, and a committed abortion provider, I was astounded at the way people spoke about physicians and ACOG. If you think OB-GYNs do anything for money you are sorely mistaken. It is a field with more work, more hours and less pay than most... I fight for the rights of women every day - and for the safety of my patients. We bear the burden of seeing the awful tragedies that can happen during delivery, while the lay public only can see statistics. Just like anti-choicers don't have to see a 16 year old's septic uterus removed, most people don't see a baby who died because of an unforseen complication during delivery or a woman who hemorrhaged to death. We SEE these things firsthand and experience the horror.... which is why we as medical professionals are so focused on safety.

as an addendum, OB-GYNS are mired in debt and malpractice insurance - none of us are going into the field to make money. I hope that people realize that there are physicians out there who fight for women's rights professionally and personally.

as a soon to be OB-GYN, and a committed abortion provider, I was astounded at the way people spoke about physicians and ACOG. If you think OB-GYNs do anything for money you are sorely mistaken. It is a field with more work, more hours and less pay than most... I fight for the rights of women every day - and for the safety of my patients. We bear the burden of seeing the awful tragedies that can happen during delivery, while the lay public only can see statistics. Just like anti-choicers don't have to see a 16 year old's septic uterus removed, most people don't see a baby who died because of an unforseen complication during delivery or a woman who hemorrhaged to death. We SEE these things firsthand and experience the horror.... which is why we as medical professionals are so focused on safety.

as an addendum, OB-GYNS are mired in debt and malpractice insurance - none of us are going into the field to make money. I hope that people realize that there are physicians out there who fight for women's rights professionally and personally.

as a soon to be OB-GYN, and a committed abortion provider, I was astounded at the way people spoke about physicians and ACOG. If you think OB-GYNs do anything for money you are sorely mistaken. It is a field with more work, more hours and less pay than most... I fight for the rights of women every day - and for the safety of my patients. We bear the burden of seeing the awful tragedies that can happen during delivery, while the lay public only can see statistics. Just like anti-choicers don't have to see a 16 year old's septic uterus removed, most people don't see a baby who died because of an unforseen complication during delivery or a woman who hemorrhaged to death. We SEE these things firsthand and experience the horror.... which is why we as medical professionals are so focused on safety.

as an addendum, OB-GYNS are mired in debt and malpractice insurance - none of us are going into the field to make money. I hope that people realize that there are physicians out there who fight for women's rights professionally and personally.