1. With only 4 CNMs (Certified Nurse Midwives) and 1 OB that perform home births in NC, women are forced to go underground to get help when delivering at home.
2. Most OBs refuse to do dual care if they know a woman is planning a home birth. Currently in Wilmington there are no OBs that have hospital privileges that will accept home birthing patients. So even if a woman wanted dual care she cannot get it.
3. In the event of an emergency, there is a loss in the continuity of care since the CPM would not be able to give any background information in the event of a hospital transfer. This creates a serious and potentially harmful gap in the care of a laboring woman. In addition to this problem, women who transfer to the hospital may treated poorly because it may be assumed that she did not care enough about her pregnancy to get prenatal care, when in fact she was well cared for by a CPM.
Why home birth and/or midwifery care? This list (pulled from NCFoM) gives a run down of the World Health Organization's recommendations and the ranking of the US in comparison to the world:
* 80% of the babies born in the world today are delivered by midwives.
* The World Health Organization recognizes midwives as the appropriate maternity care providers for most of the world's women.
* 14 other countries have lower maternal mortality than the United States. The U.S. rate is more than twice Canada's (9 per 100,000 compared with 3.2).
* The U.S. ranks 22nd in the world in infant mortality, losing twice as many babies during the first year of life as Japan (10 compared with 4.4).
* One out of every 4 American women gives birth by cesarean. This is twice the rate the World Health Organization says is justifiable.
* Midwives deliver over 70% of the babies born in western European countries that have lower infant and maternal mortality, lower cesarean birth rates and lower health care costs.
* The United States spends more money on health care than any industrialized country in the world.
* Today, only 5% of U.S. babies are delivered by midwives.
(The above data is from the World Health Organization)
There are many reasons why NC should leave the ranks of 12 states that make homebirths with CPMs illegal:
1. In a study published by the British Medical Journal, home births in low-risk, healthy women was found to be as safe as a hospital birth for comparable groups of women.
2. In North Carolina, there are approximately 600 babies born at home and only 4 CNMs, 1 OB, and 15 CPMs that attend to them.
3. According to NorthCarolinaHomeBirths.com, NC has a higher infant mortality rate than the national average.
4. There are currently 22 counties (out of 100) in NC that don't have ANY access to a birth center whether in hospital or out. NC is seriously under served when it comes to maternal care regardless of where the woman may choose to give birth.
5. For unisured women, homebirth may be a more affordable option with an average cost ranging anywhere from $600-2500. A vaginal delivery in a hospital costs $5000+ and a c-section can cost upwards of $9000.
In the Cape Fear area we are also hit hard with being underserved. Currently in Wilmington there are about four OB practices that catch babies and one hospital. The next closest option for birthing is Brunswick Medical Center. We are lucky to have several wonderful CNMs that deliver at NHMC. Unfortunantly, since CNMs are required to work under physician supervision in NC they are sometimes required to follow an OBs order, even if they disagree. Such as turning away women who want to try for a vaginal birth after a cesarean (VBAC), or pushing a woman to have a cesarean per Dr.s order when there may not be a medical need.
For more information on the state of home births in NC, and how you can help pending legislation to be passed, please go to NCFoM's website, NorthCarolinaHomeBirth.com, or NC Midwives Alliance's website.
1 comment:
This is really interesting, and an issue that has always been close to my heart. In the Netherlands, one of the places I'm from, home births are a matter of course. This keeps healthcare costs low, and is a great boon to many women who find the hospital a stressful and unwelcoming place. Childbirth is not an illness in and of itself. At-risk women should be cared for in the hospital. But, otherwise, I think at-home midwifery is a sensible choice to offer to a woman. By the way, under the Dutch system, women are given a choice. If, for whatever reason, they feel safer in the hospital, they may go there. If their doctors recommend they deliver in the hospital, insurance will not cover home birth. Doctors are always at the ready to be called in by a midwife. It seems like a great system, and the Netherlands has a great track-record with it.
Heh, I even considered becoming a nurse-midwife here in the U.S., but the hurdles are so great, I have opted to avoid the fray.
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