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Putting aside the fact that the threat of arrest makes for a stressful work environment, midwives say it also increases risks for the mother and child. In the worst case, it could dissuade or delay a midwife from transferring a patient in medical need to a hospital. (Doing so might expose the midwife to the attention of law enforcement.) But now a campaign is under way to expand state licensing of CPMs, which would not only grant mothers increased access to home births, midwives say, but also make them safer.
Momentum appears to be growing. Of the 27 midwife-friendly states, eight began licensing midwives only in the past decade. And legislatures in 10 other states are now considering bills to institute licensing of CPMs a fact that has not gone unnoticed by the medical establishment.
The Battle over Birth
The turf war between midwifery and medicine has been long-running. Both the American Medical Association (AMA) and the American Congress of Obstetricians and Gynecologists (ACOG) the professional groups that write official medical and obstetrics guidelines in the U.S. oppose home birthing on grounds of safety. In 2007 ACOG stated that the "safest setting for labor, delivery and the immediate postpartum period is in the hospital or a birthing center within a hospital ... or in a freestanding birthing center." The statement was supported in a resolution passed by the AMA in 2008. Choosing to deliver a baby at home, ACOG said, is to give preference to the process of giving birth over the goal of having a healthy baby.
Midwives counter that for low-risk mothers, planned home births are no less safe than hospital births. A study published in the BMJ in 2005 found that among 5,418 mothers in the U.S. and Canada who planned home births, the rate of neonatal or intrapartum death was 1.7 per 1,000 births similar to the rate of neonatal deaths (those occurring within the first 28 days) in hospital births found in other studies. And home birth can be a favorable experience for both mother and child, midwives say. Women who give birth at home not only recover faster after delivery but also are more likely to breast-feed and avoid postpartum depression, according to home-birth advocates.
The political debate ratcheted up on July 1, when the American Journal of Obstetrics & Gynecology published online a controversial new meta-analysis of the safety of planned home births. The authors of the paper, which consists of a review of 12 previous studies, acknowledged significant benefits associated with home birth: fewer maternal interventions, including epidurals, episiotomies and C-sections; and fewer cases of premature birth and low birth weight.
But the finding that made headlines was that planned home births led to a two-to-three-times higher risk of neonatal death than planned hospital deliveries among healthy, low-risk women. The result was especially striking, the authors wrote, because women planning home births generally had fewer obstetric risk factors than those who chose hospital births: they were less likely to be obese and had fewer previous C-sections or pregnancy complications.