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This week marks National Midwifery Week and, as a midwife who has utilized midwives for my own care, I couldn’t let it pass without writing about midwifery.
 
Midwives are becoming increasingly popular as women as a whole are starting to call for individualized care, tailored for their specific needs.  Midwives, as common as we are becoming, are still somewhat of a mystery to many people.  Midwives are sometimes confused with doulas (doulas are not healthcare providers) or considered 'less than' when it comes to providing care.  The truth is that midwives are highly-trained and skilled individuals who provide care to women in their childbearing years and beyond. 
 
You can read two different wordings of the Midwifery Model of Care here and here.  What you’ll notice in both is a focus on individualized care for each woman, not a cookie cutter approach to pregnancy, labor and birth.  Midwives are trained in normal, physiological processes, especially when it comes to pregnancy, labor, birth, and the postpartum period.  Midwives are also trained to recognize when things arise that are no longer part of the normal, physiological process and are able to make referrals when advanced care is needed.  Midwives strive to provide individualized care, which in turn fosters good communication and trust.
 
Midwives provide annual exams, family planning, prenatal, labor, birth, and postpartum care.  Midwives are appropriate prenatal care providers for low-risk women with low-risk pregnancies. 
 
My own experiences with midwives include the care of Certified Nurse Midwives (CNM’s-primarily in-hospital providers) during my first pregnancy and birth, and the care of Certified Professional Midwives (CPM’s-out of hospital providers) for my next three pregnancies and births.  My appointments were never cut short as my midwives always took time to answer my questions, as well as to check in on more than the baby’s heartrate and what I was measuring that week.  Midwives care about the whole woman, and take the time to make sure you’re healthy and well emotionally and physically.  The support of my midwives during my labors was invaluable, and I so appreciate the time they took to be with me as my body was working to bring my babies in to the world.  My midwives always treated me respectfully, and gave full informed consent about any procedures they offered. 
 
Midwives are a wonderful part of our healthcare in the United States and Iowa is fortunate to have midwives in most parts of the state.  I highly recommend midwifery care and hope that you find you love midwives as much as I do.
 
Have you used the services of a midwife?  Tell me in the comments what you loved about your care!

Welcome to Shiphrah Birth Services blog!  Thank you for joining me in my Home Birth Myths series.  So far, we have addressed home birth legality, safety, and the idea that home birth is just a trend.  This week we’re going to talk about the messy side of birth!
 
Myth #4: Home Birth is Messy!
 
Believe it or not, this is one of the hang-ups some people have when they’re considering a home birth.  Credit where credit is due, this usually comes from the male half of the expectant couple.
 
The concern here seems to be that birth, in all of its wonder, is far from clean.  I’ve heard people worry that there will be bodily fluids strewn throughout the house, and they picture placentas sitting in a bowl on the counter, used instruments sitting on their dresser, and a general unclean environment after the baby is born and the midwives leave.
 
Here’s the truth of the matter.  Birth IS messy.  Along with labor, you might (and usually do) see blood and other bodily fluids.  When baby comes, there’s more of that plus a placenta.  However, there’s something that many people forget to factor in.  Midwives.

Midwives are experts at containing messes while they’re happening so that the end ‘mess’ is manageable.  Midwives clean up the used chux pads, the bloodstains (we love peroxide’s magic!), the instruments, and the trash.  We even take care of your placenta, getting it ready to go if you’re having it encapsulated, putting it in the freezer if you’re saving it, and disposing of it if keeping it is not in your plan.  We help the new mom shower or bathe and change the bedding so that she can get into a nice, clean bed.  We also make sure to start a load of laundry before we leave, so used towels and cloths aren’t sitting around.
 
Along with cleaning up the birth mess, we clean up any messes we’ve made such as dishes that we used while at your home.  We also want to make sure that the mom, after all of her hard work, eats and drinks to replenish her energy.  This means that oftentimes before we leave, we’re in the kitchen, fixing mom some eggs and toast or another high protein meal.
 
So, is home birth messy?  It may be for a short time but when the midwives leave, the only evidence that a birth happened will be mama snuggling with her newborn baby.  And maybe a placenta in the freezer.

Welcome to Shiphrah Birth Services blog!  Thank you for joining me in my Home Birth Myths series.  So far, we have addressed home birth legality and safety.  This week we’re going to talk about another myth.
 
Myth #3: Home Birth is Just a Trend
 
A common perception about home birth is that only certain groups of people have their babies at home, or that it’s a short-lived fad.  These perceptions usually stem from a lack of knowledge about home birth and why women choose to have their babies at home.  These opinions come in the following or similar statements and often come from mistaken impressions about groups of people:
 

• Only Amish women give birth at home.
• No wealthy woman would give birth at home.
• Only rich women give birth at home.
• No college-educated woman would give birth at home.
• Only high school dropouts would choose to have a home birth.

 
There are many more variations of the above statements that simply are not true.  This is another myth that will require us to dig into studies to find accurate information.  Let’s get started!
 
The Midwives Alliance of North America (MANA) study that I referenced in Myth 2 is, once again, one of the best sources when it comes to statistics surrounding home birth.  This comprehensive study shows the following:
 

• 92% of women who choose home birth are high school graduates
• 58% are graduates of a 4-year college

 
This particular set of numbers is interesting to many people, especially those who assume that choosing home birth means you are uneducated and not very smart.  This belief often stems from those who haven’t yet learned that home birth is shown to be a safe option for low risk women.  The fact that college-educated women choose home birth is a fact that can influence the opinion of legislators who otherwise might prefer to make laws restricting the ability of women to legally choose to give birth at home.
 
The high school and college statistics also show us that it’s not just Amish or Mennonite women giving birth at home.  While many home births do take place in the Plain Community, home birth is not exclusive to the Amish or similar sects.   
 
The MANA study shows the following about payment methods for home birth:
 

• 64.4% of women self-paid (Please note that this does not mean they do not have health insurance)
• 24.2% utilized private health insurance for their home birth fees
• 8% of women who gave birth at home were on Medicaid or similar state insurance
• 3.4% paid with other methods

This information does not give income status of the women who gave birth at home, so my comments on this will be made from personal experiences with home birth clients as well as inferences from the above data.
 
Iowa Medicaid does not currently cover home birth providers so women who are lower income and on Medicaid are paying out-of-pocket or denied access to a home birth because of the lack of coverage.  Women who do have non-state insurance may choose to submit their costs to their insurance company and see if they can be reimbursed.  Some midwives in Iowa do accept insurance and utilize a biller who can help clients determine what kind of coverage they’ll have.    Most insurance companies will not cover 100% of the cost of home birth but many will pick up some of the cost.  Christian healthcare sharing companies usually cover home birth.  Samaritan Ministries is the best of all of them as they cover home birth without question and without requiring a deductible be met.  Home birth expenses are also considered qualified expenses for Health Savings Accounts (HSA) and Flex Spending Accounts (FSA).
 
The information from MANA as well as what I’ve seen in Iowa indicates that women across all socioeconomic groups are choosing home birth, with middle class women having more accessibility from a financial standpoint.  That said, many home birth clients do qualify for state insurance but because they believe home birth is the best option for them they will find a way to pay their midwife.
 
MANA also touches on the statistics of first-time vs. non-first time moms choosing home birth:
 

• 22.3% of women choosing home birth have never given birth prior to their current pregnancy
• 77.7% of women choosing home birth have given birth prior to their current pregnancy
• 9.2% of women choosing home birth have been pregnant 5 or more times

 
This is a pretty straightforward observation.  Women who are pregnant for the first time choose home birth at a lower rate than non-first time moms.  From a personal experience standpoint, this is often because women learn about home birth as an option after they’ve given birth, or they feel more comfortable giving birth at home after having already had a low-risk pregnancy and birth.
 
Who else gives birth at home?  Let me preface this by saying that one should never make important life choices based on what celebrities choose to do, but I thought you might enjoy seeing some of the actresses, singers, and models who have given birth at home with a midwife in attendance:
 

• Mayim Bialik (my personal favorite-a neuroscientist, actress, AND chose home birth?!)
• Melora Hardin (The Office, anyone?)
• Maya Rudolph (her first labor and birth went so fast that her first home birth was an unplanned home birth!)
• Alyson Hannigan (Most notable as Lily, from How I Met Your Mother)
• Julianne Moore
• Meryl Streep
• Demi Moore
• Pamela Anderson
• Cindy Crawford
• Ricki Lake (you might know about her birth from her documentary Business of Being Born)
• Alanis Morissette
• Jennifer Connelly
• Gisele Bundchen (your husbands might know of her husband-Tom Brady)
• Maria Bello
• Nelly Furtado
• Lisa Bonet

 
I hope that helps give a better picture of who chooses home birth.   If you have had a home birth and want to offer your insight, please feel free to comment on the blog post.
 
Source:
Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009
http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full
 
 

Welcome to Shiphrah Birth Services blog!  Last week, we kicked off a series that delves into myths surrounding home births by addressing the myth that home birth is illegal.  This week we’re going to jump into another common myth about home birth.

Myth #2: Home birth Isn’t Safe.

This is a much debated topic and, because it is a big topic, this post may become lengthy though I’ll try to be short and sweet while presenting the data.
 
I want to start with a word about home birth midwives and their training.  Most home birth midwives are trained through the apprenticeship model, meaning they have trained for several years with a home birth midwife.  They attend prenatal visits, labors, births, and postpartum visits with the midwife from the very beginning of their training.  As time goes on and they advance in their knowledge and skills, they move from the assistant midwife role to the primary midwife role, with the midwife supervising.  Apprentices also choose to self-study midwifery texts or may enroll in programs with specific plans of study.  Many midwives choose to become a Certified Professional Midwife (CPM), which involves showing proof of the specified clinical training requirements.  This certification includes proof that you have met the clinical requirements and have passed the 8-hour exam.  CPM’s are required to recertify every three years, and must stay current on neonatal resuscitation (NRP) and CPR certifications.  CPM’s are also required to show evidence of a specific number of continuing education credits before they can re-certify. 
 
CPM’s are unique because they are the only providers specifically trained in out-of-hospital birth.  This means that these midwives need to be especially attuned to the realm of normal, and they are trained to recognize signs that indicate something is moving outside of the range of normal.  This knowledge and training is what helps midwives recognize the need to transport the expectant mother from a planned home birth to a hospital setting before an emergency situation happens (it is important to note that most home birth transfers occur due to long labors and the client desiring pain relief.  I’ll share more about this when we share the studies).  Midwives are trained to manage complications such as hemorrhaging, dystocia, cord prolapse, newborn resuscitation, shock, etc.  Midwives in Iowa attend births in pairs, or with a skilled birth assistant who has been trained to manage complications.
 
When we start talking about home birth safety, I want to note that home birth is not the best option for every woman.  Studies repeatedly show that a planned home birth is most safe for low-risk women who also have a skilled midwife in attendance.  Women who have high-risk factors would likely be referred to a hospital setting.  Unassisted birth, while a choice a woman is free to make, is not statistically shown to be as safe as a midwife-attended birth.

Now on to the studies!  The United States has historically relied on home birth studies performed in other countries, due to the comparatively low number of out-of-hospital births that take place in the United States.  However, in 2014 a landmark study was released by the Midwives Alliance of North America (MANA) that detailed the safety of planned home births in the United States.  This study was performed using data collected from 2004-2009, and totaled a number of 16,924 planned home births. 
The main findings are detailed below:

• 5.2% cesarean rate for women who planned a home birth (1), compared to the national average of 32% (2).   
• 11% intrapartum transfer rate, the majority were transported for Pitocin and/or epidural.
• 87% VBAC rate (1), compared to a national rate of 60-70%.
• 4.5% of women received oxytocin and/or an epidural (1) compared to the estimated national rate of 57% (3) and 61% (4) respectively.
• Early neonatal mortality rate of .41/1,000 (1) compared to the U.S. average of 3.28/1,000 (5).

 
This particular study is the only one of its kind because it’s the only U.S. study that looks just at births that are planned out-of-hospital births.  This is a big deal!  Just a few years ago, there was a study published that claimed out-of-hospital birth was unsafe, and that the mortality rate was higher than that of births taking place in the hospital.  This study was faulty because it relied only on birth certificate data, which meant that it included ANY birth that took place out of the hospital.  This meant that planned home births were included in the same numbers as unplanned home births and planned unassisted home births.   
 
The MANA study, however, shows that planned home births of low risk women, attended by CPM’s, are just as safe as hospital births and lead to lower rates of medical intervention.  This compares with out of country studies where midwifery care is much more common.
 
I know not everyone enjoys researching studies, but I hope this has given you more solid information regarding evidence of home birth safety.

Sources:
1. Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009 http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/full
2. https://www.cdc.gov/nchs/fastats/delivery.htm
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3947469/
4. https://www.cdc.gov/nchs/data/nvsr/nvsr59/nvsr59_05.pdf
5. https://www.cdc.gov/nchs/products/databriefs/db169.htm
 

Welcome to the maiden post of Shiphrah Birth Services blog!  Thank you for visiting my website. 

My name is Bethany Gates, and I am a Certified Professional Midwife (CPM) and a Certified Doula.  I provide home birth midwifery care for women planning a home birth, and doula services for women desiring a hospital birth and wanting the support of a doula.
 
Because home birth has only recently re-emerged as a mainstream alternative to hospital births, I thought it fitting that I start this blog by introducing a series of posts that address the common myths surrounding home birth.  The first myth I want to address is one of the most common objections you’ll hear when talking about home birth.  Keep in mind that as I am based out of Iowa, I am addressing this post with Iowa law in mind.  Every state has its own laws regarding the practice of midwifery so if you’re not in Iowa, please research your own state laws.
 
Myth #1: Home birth is illegal.
 
This is one of the biggest objections to home birth that you might hear when looking into a home birth.  It is a common misconception that only Certified Nurse-Midwives (CNM’s) can attend home births in Iowa.  However, with 50 different states that have the freedom to make their own laws, there are 50 different possibilities for addressing the legal status of CPM’s and direct entry midwives. 
 
There are several common approaches states take when it comes to home birth and home birth midwives.  
Approach 1: States require midwives to apply for and receive a license to practice legally in their state.
Approach 2: States offer a license for midwives who wish to apply for one, but do not require a license to practice (this is most notable in Minnesota).
Approach 3: States do not address midwifery in their law at all and midwives practice without state regulation/rules.
Approach 4: States specifically list midwives as providers in their law but do not offer or require a license.

Iowa fits in the third approach, where the Iowa Legislature has never passed a law regulating home birth midwives.  There are some people who believe that non-nurse midwives could be charged with practicing medicine without a license, but in 2013 an Iowa judge ruled that midwifery is not the practice of medicine or nursing, and stated that because Iowa has no law regulating CPM’s or traditional midwives, a midwife should not be charged with practicing medicine without a license.
 
The number of Iowa women who give birth at home each year has increased from 370 ten years ago to over 500 each year!  The vast majority of these births are attended by Certified Professional Midwives or traditional midwives (apprentice-trained, but have not gone through the certification process).  At this time, there are no CNM’s who attend home births in the Cedar Valley so home births are attended by CPM’s and traditional midwives. 
 
As of 2012, the United States out-of-hospital birth rate averaged 1.36% with some states seeing as many as 6% of births taking place outside of the hospital.  Iowa ranges between 1-2% of all births taking place at home.  The number of out-of-hospital births continued to rise. 
(https://www.cdc.gov/nchs/data/databriefs/db144.htm#x2013;2012%3C/a%3E)

My next post will address another common myth about home birth: Myth #2: Home Birth Isn’t Safe.
If you have a myth or question about home birth that you would like me to talk about, please contact me.