Midwives are awesome…unlicensed midwives, not so much

After reading this WaPo story about a local midwife charged in the death of an infant, I debated whether I wanted to comment on this at all. I have a bad feeling that no matter what I say or how carefully I say it, I’m going to offend someone. ::sigh:: But I’ll do my best to tread carefully on a very personal issue.

Let me start by saying that I absolutely positively think that women need more control over the birth process. And after long internal debate, I’ve concluded that I support the right for women to choose a homebirth, if that helps them.

I also believe very firmly that no matter how crunchy granola the homebirth, there should be some kind of licensed medical professional present. That can be a certified nurse midwife, for example.

I love nurse midwives, oh yes I do! I moved OB/GYN practices to one that was significantly less convenient, purely because that’s where my nurse midwife went.

Licensed doulas? Licensed birth attendants? Basically, I don’t care what title they have, I just want to know that there’s someone attending the birth that knows something about medicine and has proven they know what to do in case of emergencies. They don’t have to have graduated medical school and I don’t care if they can treat cancer or whatever, but they should know every bloody thing they can learn about childbirth and potential problems.

I must say that I agree with the prosecution of an unlicensed midwife. Reluctantly, but I agree. Maybe she’s amazing and wonderful and knowledgeable. Or maybe she’s a nightmare who believes that bad pregnancy outcomes can be avoided by praying rather than doing anything. We don’t know!

Of course, I should also note that there is no way on this earth I would have chosen a homebirth, but hey, different strokes and all that 🙂 I did come within a millimeter of choosing a midwife practice that had their own standalone facility, though. It’s probably good that I didn’t, since they would have had to kick me to a doctor once my pregnancy went high risk, but I definitely checked into it.

Of course, I decided against the midwives once I remembered that, uh, I’m a complete and total wimp when it comes to pain. However, I think this WaPo blog post describes one of the happy medium possibilities. If I’d had the option of a homelike birth that was in a hospital, with a midwife attending, I might have been willing to take a chance.

But I digress. When it comes to safety, hardliners on both sides claim that “homebirths/hospital births are much more dangerous!!!!” As usual, I’m going to argue that the truth is much more complicated 😀 (Yes, regular readers will notice a regular theme.)

I think it’s completely useless to say that one or the other is safer or more dangerous. Safer for the mother or the baby? Under what circumstances? With what medical conditions?

I’m sure that in a completely boring and normal pregnancy and delivery, a homebirth attended by pretty much anyone with a clue will be just as safe (if not safer!) than a hospital. I share homebirth advocates’ concerns about high c-section rates and aggressive medication when it’s not necessary. And hey, if we knew in advance who was going to have that boring and normal experience, we’d be in good shape.

Conversely, I’m equally certain that in cases of severe complications, a hospital birth attended by highly trained surgeons and nurses is safer. I share the medical professionals’ concerns about hemorrhaging mothers and babies in need of immediate care. And if we knew in advance who was going to have that experience, we’d be in good shape, too!

But what about the case of a woman with diabetes who’s otherwise healthy, has delivered easily once before, with a breech baby who’s a week and a half overdue?

Or the woman with preterm labor, a past preemie and a previous c-section and a bad case of panic disorder? (Oh wait, that’s me. ::coughs::)

Every woman needs to be able to consult with doctors and midwives and find a solution she’s comfortable with. And if there are risks and she really needs to be in a hospital, then hospitals need to be less, well, hospital-like!

Homebirth advocates say that pregnancy is not a disease and they’re right. But that doesn’t mean it’s always safe and easy! Skydiving isn’t a disease either, but believe me, if I’m jumping out of an airplane, I want the dude checking my parachute to know his stuff.

Not that I’m going to jump out of an airplane, mind you. Pregnancy and childbirth were terrifying enough for me 😉

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About mamamara

I'm a 40-year-old, work-at-home mother of two. I'm pro-vaccine, pro-medicine, pro-science, and an avid reader of information about all of the above, and I want to combine my love for my children with my love for science. So here we are!
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2 Responses to Midwives are awesome…unlicensed midwives, not so much

  1. Christine Watsky says:

    Great commentary, Mara. I agree absolutely that it is complex. Like fixing public schools, i believe we should fix hospitals too so they are homelike and not dangerous. Easy to say, huh?

    • mamamara says:

      Yep 😀 But I do think this is easier than fixing the schools! I don’t think that integrating midwives and doulas and making the L&D rooms more comfortable is as hard as some hospitals think. I do sometimes wonder if having a doula at Yael’s birth might have helped me avoid the c-section. ::shrug:: It would have been helpful, certainly.

      Now we just have to convince insurance companies to cover midwives and doulas…which is a factor I forgot to mention above. ::sigh::

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