Legal Issues in Homebirth Midwifery

Okay, so let me try to explain a convoluted issue  as simply as possible:

Here in North Carolina, only certified nurse-midwives are legally allowed to attend homebirths. Those certified nurse-midwives have to have back-up (sponsorship, essentially?) by a doctor. Most doctors do not want to support a nurse-midwife attending homebirths, for various reasons: the doctor thinks homebirth is not safe; the doctor does not want the nurse-midwife taking clients from him; the doctor’s malpractice doesn’t allow homebirths without a huge cost; or the hospital where the doctor works doesn’t allow him to support homebirth. In North Carolina, there are either 11 or 12 certified nurse-midwives who attend homebirths. Most of them are supported by Dr. Henry Dorn, who has written against about the over-medicalization of childbirth.

My Masterpiece, born in a birth tub in our bedroom in Arizona with a certified professional midwife.

There is a national credential for non-nurse midwifery — the certified professional midwife — and yet midwifery is regulated state-by-state, with states like North Carolina who don’t recognize the cpm credential. Some states require another credential, a licensed midwife, which is like a cpm+ a few other things. Some states have other requirements, like less or more — did I mention it’s a mess?

Last year near Charlotte NC, a well-known non-nurse-midwife who was a certified professional midwife was arrested, and North Carolina Friends of Midwives held a rally. (Ironically, the rally was here in Raleigh — little did I know I’d be living here a year later. Sigh.) Recently another Charlotte midwife was arrested after a baby died. This midwife was not a certified professional midwife; she was a direct-entry or “lay” midwife.

All of these leads me to the following conclusion: midwifery in North Carolina — and probably in other states where non-nurse midwives are not legal — is a mess.

My Masterpiece and I are checked by a certified professional midwife. Later I transported to the hospital for a retained placenta and postpartum hemorrhage.

certified professional midwife checks My Masterpiece and me. Later I transported to the hospital for a retained placenta and postpartum hemorrhage.

On one hand, I believe that women should be allowed to choose their provider. Whether that means a certified professional midwife who isn’t a certified nurse midwife, a midwife licensed in another state, or just a direct-entry midwife who isn’t certified, I think a woman should be allowed to choose. Without the government having a hand in that decision!

However, I also believe that the midwife owes the client an accurate portrayal of her credentials and her experience, or lack thereof. I think she needs informed consent. Also, that informed consent needs to include the risks of choosing a provider who might be in legal trouble if she has to transport a client (which happens if there is a situation that the midwife cannot handle, either before, during or after the birth). Such a situation might lead a provider to either (a) not transport even if the client is in need or (b) transport and dump the client so she avoids legal issues. (I’m assuming worst-case scenarios here. I would like to hope that most midwives wouldn’t do either.) So in that respect I want some legal intervention, for lack of a better word. I want some requirements.

Porcelain, born at home in Charlotte on the toilet. Her birth went perfectly.

This is a very complicated issue. I think it’s also a feminist issue; the skeptic/pessimist in me wonders if this would be so convoluted if it involved mens’ bodies?

I don’t think this issues is going to be solved anytime soon. What do you think?

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2 Responses

  1. We have faced many of the sames issues at our Charlotte midwife Center (http://carolinabirth.org/midwives/), but the struggles are diminished by the lovely work we carry on doing. If anyone has questions about Midwifery in Charlotte, NC, feel free to get in touch!

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