UT: Economy leading more women to midwives
The Deseret News reports…
The slumping economy is becoming a factor in where some Utah women decide to give birth.
Licensed home-based midwives say they’ve seen a slight increase in business in part because their service tends to be less expensive than giving birth in a hospital.
“The fact (that) people are having a lot of financial troubles is causing people to look for alternatives,” said Suzanne Smith, a midwife who said she is taking more calls from people who are uninsured or have high deductibles.
Consulting appointments are also up at BellaNatal, a one-room birth suite in Orem run by Smith.
At the Birth and Family Place, a birth center in Holladay, the number of women touring the center who say they’re attracted by the price has risen to about one-third, according to medical director Rebecca McInnis.
“I don’t think it’s been that high before,” McInnis said.
A hospital-based birth can cost about $8,300, including about $6,000 on average for the hospital charge, according to 2006 estimates by the state health department. Deliveries at home or at a birthing center can be substantially less expensive.
Still, midwives said, cost is rarely the only factor in deciding to give birth at home or at a center. It typically only makes sense for women with low-risk pregnancies and for those willing to forgo epidurals and Caesarean sections. Women have to weigh the risks and benefits of giving birth outside of a hospital, they said.
“You really should be where you feel safe, where you feel good,” Smith said. “Nobody’s going to go to the cheapest place when it comes to the life of their baby.”
Paula Williams of Provo said she wanted to give birth at home with her second child. She said she was dissatisfied with the hospital birth of her first child. Cost was also a factor in considering the birth of her second. Williams, who doesn’t have insurance, delivered her son in a bathtub at her parents’ house in November and was glad she did.
“It was a lot better experience. I got to do it my way,” she said. “I will be doing it again, not just because of the money.”
ISRAEL: Gave birth at home? Somebody lost NIS 8,000
From Haaretz Daily Newspaper Israel:
Why are hospitals opposed to women giving birth at home?
Each year, about 150,000 babies are born in Israel. Hospitals vie over the mothers, tempting the women with posh delivery rooms, private midwives and even hotel suites. But the big money is not coming from the expectant mothers, it is coming from the state.
“The condition that makes the most money for hospitals is birth,” said Shlomi Friedman, who is promoting an amendment of the Birth Allowance law and fighting injustice in the National Insurance Institute’s treatment of mothers based on where they give birth. “They make NIS 8,000 per birth, which generally doesn’t involve complications.” And that is one reason the hospitals do not want Israeli women to give birth at home.
Obstetrician Avner Shiftan points out that encouraging home births would save the state heavy costs on hospitalizing birth mothers, but hospitals hate the idea. “Hospitals have rigid costs, such as construction, buying equipment and salaries. The fewer mothers come, the more income they lose,” he explained.
One way the state discriminates against home births is through birth allowances. The allowance ranges from NIS 470 to NIS 1,489, depending on how many children the mother has. But she only gets it if she gives birth in hospital. No hospital, no money - unless she shows up within 24 hours of the birth and stays for at least 12 hours.
The reason the state discourages home births, incidentally, is because to support them properly, as The Netherlands does, for instance, it would have to invest massively in support systems. Read more
California: Documentary has some expectant moms aiming for home births
From the Sacramento Bee (pictures there):
Marie Long took a page from Ricki Lake’s book a few weeks ago, giving birth to her daughter Katelin at home, in a tub filled with water.
Actually, the Orangevale mom was way ahead of the former talk-show host. All three of Long’s children, including Hyrum, 4, and Elaina, 2, were delivered at home.
The vast majority of people still have their babies in hospitals. But thanks in part to the widely praised documentary “The Business of Being Born,” in which executive producer Lake is shown birthing her baby Owen in a tub in her home, that may be changing.
“Ever since ‘The Business of Being Born’ was released, we are getting probably twice as many calls,” said Claudia Breglia, a Sacramento licensed midwife who presides over home births. “I would estimate that a third of the people who call us mention the film, and they are mostly mainstream, educated people, not people who are on the fringe.”
Released this year, the documentary portrays home birth as a less costly, more satisfying and healthful alternative to delivering babies in hospitals. Technology, the film suggests, has wrongly transformed childbirth from a natural process into an unnecessarily complicated medical procedure.
Many doctors disagree. The American College of Obstetricians and Gynecologists has issued a statement in opposition to home births, arguing that hospitals are the safest places to deliver babies.
“Childbirth decisions should not be dictated or influenced by what’s fashionable, trendy, or the latest cause celebre,” the group said in a written statement.
Breglia said the dangers of home birth often are overstated. Serious complications are unusual, she said, and midwives carry medicines and equipment to deal with them. They also are prepared, she said, to quickly take a patient to the hospital if necessary.
In the 2005 study, researchers found that about 12 percent of 5,418 women who intended to give birth at home ended up going to the hospital because of complications. Numbers of deaths were comparable to rates for babies whose births began in hospitals.
North Carolina: Homebirth midwives push for state licensing
From the StarNewsOnline.com:
Kirsti Kreutzer had her first baby at a hospital and the second in her living room.
“It was a night-and-day difference,” the Wilmington mother said about the two labor experiences. “I was able to walk around my house, eat when I wanted.”
She had her daughter in a pool designed for water deliveries, aided by a midwife.
But it was somewhat of an underground process for Kreutzer.
There was no local directory of home midwives to look up, no way to check formal complaints or compare backgrounds.
Though certified nurse midwives, who work primarily in hospitals or private practices and under physician supervision, are recognized by the state, the other field of midwifery that focuses on home births is not licensed in North Carolina.
To practice midwifery without a license is a misdemeanor, even though there is nothing outlawing giving birth at home.
Twenty-four other states - including South Carolina, Virginia and Tennessee - do license direct-entry midwives, also called certified professional midwives.
They are not required to have nursing degrees like nurse midwives but do have to meet national certification requirements that include testing and at least a year of clinical experience observing and participating in births.
A legislative committee currently is studying the licensing issue in North Carolina and proponents hope to have a bill introduced in Raleigh next year.
A similar push several years ago failed amid objections from the medical industry and obstetricians concerned about the safety of home births as well as the oversight of direct-entry midwives.
“If there was licensure in place, there would be more midwives trained here, and there would be a selection. No one’s going to move to a state that’s not friendly to midwives,” said Kreutzer, a member of the North Carolina Friends of Midwives.
Members of the local chapter have approached lawmakers whenever they can and are planning an event Saturday to raise money for more lobbying.
Edward Newton, president of the North Carolina Obstetrical and Gynecological Society, said he supports midwifery as long as there is proper oversight.
“A woman with no medical problems with support probably will do very well at home, but the reality is that 1 in 100 will have a situation that either the mother or the baby are at risk,” said Newton, who also is professor and chairman of obstetrics and gynecology at East Carolina University’s Brody School of Medicine, which has the state’s only nurse midwifery program. “I know that myself and most obstetricians like the fact that I have a whole team of people that can help me keep these women and babies alive.”
Russ Fawcett, legislative chairman for North Carolina Friends of Midwives, said certified professional midwives are trained in difficult births and have to meet rigorous standards.
“There are women birthing at home unassisted because they don’t have access to midwives,” said Fawcett, who lives in Wilmington.
The legislative study committee already has met twice and is expected to hold another meeting after the end of the current short session.
At one meeting in February, Fawcett showed lawmakers a 2005 study in the British Medical Journal that among 5,400 women in North American who had home births with a certified professional midwife, no mothers died, five babies died and 12 percent of the cases were transferred to the hospital.
Caesarean sections, however, were reduced to one-fifth the level in comparable groups, the study showed.
The North Carolina Medical Society also has spoken against the licensing proposal, said Chip Baggett, the group’s legislative director. He said the physician’s group also supports the existing system of nurse midwives in hospitals, birth centers and ambulatory centers - but not at home.
Newton said he backs the certification process for nurse midwives, who can practice in any state, and points out there is an option for people to be certified even without a nursing degree.
The American College of Nurse-Midwives allows those with any college degree to become certified midwives, though the requirement is being upped to a master’s degree.
Newton said he would prefer to see that mechanism used rather than have a separate license for professional midwives.
“If the issue is going to be passed by the legislature,” he said, “then I want to see full visibility, collaboration (with a supervising physician) and adequate training.”
North Carolina: Midwives Want Statewide Licensing
From WSOCTV.com:
WILMINGTON, N.C. — Midwives are hoping to establish a statewide licensing program to help expectant mothers find qualified midwives to help during home births.
The Star-News of Wilmington reported Friday the field of midwifery that focuses on home births isn’t licensed in North Carolina. The state does recognize “certified midwives,” who primarily work in hospitals or private practices under the supervision of a physician. Home midwives are not required to have nursing degrees. But they must meet national certification standards, including one year of clinical observation and participation in births. Supporters want the Legislature to consider a bill next year to establish a state licensing program, which exists in 24 other states. A similar effort was unsuccessful several years ago amid objections from medical professionals concerned about oversight and the safety of home births.
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