Home Births on the Rise
According to North Carolina Friends of Midwives (NCFM) founder Victoria Brown, fewer than 10 certified nurse midwives (CNMs) practice home births in North Carolina—and only two of them travel to the High Country for legal out-of-hospital deliveries.
Citing a new study from the Centers for Disease Control and Prevention (CDC), Brown said there was a “rising need for midwives to cover the whole state.” In May, the CDC reported that U.S. home births increased 20 percent from 2004 to 2008.
Brown said that the reason for the low number of midwives in the state is because it is currently a misdemeanor for those trained in home births, i.e., certified professional midwives (CPMs), to practice in the state of North Carolina. To become a CNM, prospects must be registered nurses and receive a master’s degree in midwifery. On top of that, the CNMs must have a doctor sign off on protocols.
“Many of the [midwives] find it very difficult. They do not have an autonomous practice in this state,” Brown said. “[That] is the major barrier.”
CPMs are legally recognized in 27 states, including Virginia, Tennessee and South Carolina—but not North Carolina.
Lisa Goldstein, CNM, who attends births in Avery County, among other counties, and Karen Benfield, CNM, MSN, are the two midwives who practice home births locally. Benfield works a 200-mile radius around her main office north of Hickory, and she also operates out of a home in between Blowing Rock and Grandfather Mountain. Though she has attended and supported more than 860 successful births since 1981, she didn’t become a CNM until 2009, before which she had to be very covert about her services, she said. Of those 860 births, only a few resulted in a transport to the hospital, with no fatalities.
“I absolutely love being a midwife,” she said. “I really truly love helping women and families have a baby in the environment they choose and being a guardian for mother and baby.”
She opened her practice, BirthTender, in March 2011. Though she hasn’t midwifed in the High Country since becoming a CNM, she has home births lined up for next winter.
In 1992 and 1994, Patricia Townsend of Zionville hired Benfield to help deliver two sons. She said after reading and hearing birthing stories, she didn’t want to have a hospital birth, though she said the hospital has its time and place in certain instances when mother and baby may be in danger.
“Many hospital interventions didn’t always seem necessary,” Townsend said. “As far as a healthy pregnancy [is concerned,] it just seemed right for us.”
Townsend said she had no regrets whatsoever and that the home birth was very comfortable for her.
“It was much easier to relax amidst labor, if you can be relaxed,” she said laughing. “But because I was in my own home, I could get up and walk…lie down…have my own food and drinks [all] whenever I wanted too. It was just a very comfortable place to be.”
Both Brown and Benfield said people have misconceptions regarding home births, such as its legality, professionalism and safety
“Many think it is illegal,” Benfield said. “You can have a baby at home, under a tree or in the mall, wherever you want.”
Benfield said, the legality issues arise with the midwife not being a CNM; the mother is not breaking the law having a child outside of a hospital.
Home births regarded as unsafe or less safe than hospital births is another misconception, Brown said.
“There are lots of studies that show it’s safe, if not safer than hospital births,” Browns said. “So it is a safe option.”
Heather Jordan, CNM, MSN, at the offices of Dr. Charles Baker, delivers babies at Cannon Memorial Hospital in Linville and has been a CNM for nine years. She said she is really happy with her hospital-based practice. She said she isn’t against home births and is glad that women have options, but that they certainly aren’t for every one.
“Sometimes I get nervous when people make decisions, and they don’t seem well informed about both the risks and benefits [of home births],” Jordan said. “But a really good home birth midwife or CPM does go over [those risks].”
Benfield screens her future clients before accepting them. If those clients have contraindicating factors that could cause problems during pregnancy, she will refer them to a hospital. Such factors include persistent anemia, persistent high blood pressure, juvenile insulin diabetics and so forth.
One reason her transport rate to a hospital during pregnancy is so low, she said, is because she catches complications early and also because she encourages her clients to maintain a healthy, active and nutritious lifestyle.
“Home birth is a safe and viable option,” Benfield said. “But we need to understand and handle complications and refer people when we truly need to and it’s beyond our capabilities.”
Brown of NCFM said the tide is turning with regards to the popularity and public knowledge of home births. She said over 600 people recently marched in Raleigh to support legislature that would make CPMs legal for N.C. home births. House Bill 522 and Senate Bill 662 were filed in the House and the Senate several months ago, Brown said.
“The legislators are well aware of it, and we are trying to get [the bills] through in the next session,” Brown said.