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Normal Birth Forum Featuring Henci Goer
Subject: "A Home Birth Would Have Killed Me/My Baby"

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IdahoMama (guest)

07/26/2008 7:45 PM Quote Reply
I know that women who make this comment often have a poor understanding of the training and qualifications of Certified Professional Midwives and Certified Nurse Midwives, (those who attend home births, at least), including the ability to recognize high-risk situations and refer out when necessary.  They are also unfamiliar with the research that confirms well-attended home birth a safe option for low-risk pregnancies. 

It doesn't help that their fear-mongering OB's are confirming these misconceptions.  The ACOG's anti-home birth statement wags its finger at women with a reminder that "complications can arise with little or no warning even among women with low-risk pregnancies."  

In line with this statement, these women usually mention events that "came on suddenly."  I know that CPMs carry appropriate equipment and are trained in neonatal resuscitation.  I also know that with the liberal use of pitocin in hospitals, fetal distress is all too often iatrogenic.  But I'm curious about other complications. 

I most often hear about pre-eclampsia and placental complications (e.g. placenta accreta).  How are Certified Professional Midwives trained to detect and respond to these complications?  And are there any similarly risky complications that I'm not considering? 
irishgirlz (guest)

07/27/2008 5:58 PM Quote Reply

I am the mother of four and a birth doula. I gave birth to my two youngest children at home attended by an excellent CPM. I find what you have written to be thought provoking mostly because as an aspiring midwife, I think about the issues surrounding the education of midwives endlessly. It was a struggle to decide which path to take. On the one hand, CPM training through a MEAC accreditted school would be the most APPEALING to me as a woman who wishes to attend low risk mother's at home, but complications in low risk women can and do happen and often without much warning. Knowing this fact and realizing that losing a baby or mother as a result of my lack of knowledge or experience is just not an option. This is why I have decided to earn my Bachelor's degree in nursing and then go through a CNM graduate program. I have made this decision, not because I feel ALL CPM's are undereducated, but because I believe a minority of them do not appreciate the weight of attending births at home and don't have sufficient experience. There are many opportunities for new CPM's to get EXPERIENCE with a myriad of complications, but it entails working at a birth center in Texas or going out the country to attend foreign women. Usually a midwife who chooses to do this sees complications and issues she would never see  working with a homebirth preceptor in the US, not once but many times. It helps her to learn not only how to manage these kinds of complications, but how to recognize them in time. This  type of enrichment in the current CPM training is, in my opinion, essential to building a good homebirth midwife, but it is not a requirement. Working in a hospital (to gain experience) will be very hard for me, but I will see complications and high risk cases and that is what I need in order to feel comfortable and confident caring for low risk moms and babies at home.  We all need to work together to keep homebirth safe and legal. Pretending that there aren't tragic, preventable accidents that happen at homebirths caused by a lack of knowledege is counter productive to this cause. It does happen and when it does, it gives midwifery a bad name. Here is a birth story from MDC illustrating what I'm talking about.

 http://www.mothering.com/discussions/showthread.php?t=691709

I realize that many atrocities also happen to women when attended by OB's in the hospital. However, I'm not trying to become the best OB, I'm trying to become the best MIDWIFE I can be. I want to keep homebirth a viable, safe option for low risk families and in order to do that I think the next generation of midwives need to make demands of themselves to go above and beyond with our education and experience.

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