Home births in demand in Maryland but licensed midwives scarce

homebirth1By Kristy MacKaben

 Noel Sophia Goudy came into the world much like her mother—by way of a home birth in her Severna Park home with the help of her grandmother, a midwife.

The 7-pound, 4-ounce baby girl was born at 12:09 p.m. the day before Valentine's Day in a warm birthing tub in the middle of her living room. Noel's mom, Alexa Goudy caught Noel's head, and her grandmother Susan Dodge, a licensed nurse-midwife, helped pull out the rest of her body.

As Noel snuggled on Alexa's chest and her husband, Chet, embraced them tightly, Alexa's homebirth convictions were strengthened.

"It was an easy decision. I was born at home and my mother delivers babies at home," Alexa said. "I kind of always knew I would do that."

Unlike her daughter, Dodge wasn't exposed to the concept of home birth at a young age. She didn't hear about the option until she was pregnant with Alexa and a friend gave birth at home.

"It appealed to me," Dodge said. "I think home birth feels like a normal thing to do. We want to use our bodies to birth babies, and home is the setting where that is expected and supported."

Maryland home births on the rise

Though home births still make up less than 1 percent of all births in the United States, they are becoming more popular. The National Center for Health Statistics released a report earlier this year, indicating a 29 percent jump in home births from 2004 to 2009. Home births have taken hold locally as well, with Anne Arundel County reporting 37 women delivering at home in 2009, up from 13 in 2000.

Supporters say that home births are a more personal, natural, drug-free experience. When having a baby at home, women can move around freely and labor at their own pace, and are allowed more family bonding time without interruption once the baby is born, Dodge explained.

Women who use midwives get more extensive personal care and education during prenatal visits as well, Dodge said. An average visit with a midwife may last 45 minutes, while time with an obstetrician may be much shorter and not as involved, she added.

"I get to know (my patients) personally because an important part of my role is to develop a trusting and mutually understanding relationship," Dodge said.

The home birth experience can also be much less expensive. Although not all insurance agencies cover home births, Dodge's fees for everything from prenatal visits to the birth are about $4,000. Hospital births (not including obstetrician visits) could cost $9,000 to $17,000, according to costhelper.com, an online resource for parents.

Great home birth debate

The increase in home deliveries has created a firestorm of debate about the safety of home births and who should be attending them, especially in Maryland, where a piece of home birth related legislation is under debate.

Home birth is legal in Maryland, but the state specifies that only nurse-midwives (midwives with nursing degrees) can be licensed to attend home births here.

"There is an increase in home births all over the state," said Fran Phillips, Maryland's deputy secretary for public health. "There's nothing in and of itself that's wrong with home birth. What's important is that it's a safe birth, whether it's at home or in a hospital."

In some cases, home births with unlicensed midwives have ended in tragedy—most recently in Alexandria, Va., where a baby died after being delivered by a Baltimore-based midwife, followed by the death of another baby in St. Mary's County, Phillips said. So the goal of the Maryland Department of Health is to ensure families are using nurse midwives with adequate credentials, she said.

Licensed vs. certified midwives

But because only a handful of nurse-midwives actually attend home deliveries in Maryland, families have been forced to use certified professional midwives, who are not licensed in the state, and therefore are illegally attending home births. Certified professional midwives are licensed to attend home births in 26 states, but not Maryland.

Maryland Families for Safe Birth, a pro-home birth nonprofit based in Hagerstown, is asking Maryland legislators to pass a bill allowing certified professional midwives to be licensed in the state. The bill was introduced in early February but nothing had been determined at press time.

"The issue really is, there aren't enough midwives to meet demand," said Jeremy Galvan, president of Maryland Families for Safe Birth. "If you want to have a home birth in Maryland, you almost have to have a non-licensed midwife."

Across the country, about 1 percent of nurse-midwives attend home births, 97 percent work in hospitals, and the remaining 2 percent work in birth centers, said Mairi Breen Rothman, a licensed nurse-midwife in Takoma Park, who attends home births. Rothman said there is a need for more licensed midwives.

"My preference would be that anyone doing births in the state of Maryland would be licensed, so they could be regulated and held accountable," Rothman said, indicating her belief that certified professional midwives should be licensed in Maryland.

Phillips, however, disagreed. The lack of licensed midwives should not result in families lowering expectations, she said.

"The response of the shortage is not to say we'll reduce the quality expectations," Phillips said.



Are certified midwives safe?


The Maryland affiliate of the American College of Nurse-Midwives, a professional organization that represents certified nurse-midwives and certified midwives, is also against licensing certified professional midwives for home births. The organization maintains certified professional midwives do not have proper training and education to deliver babies at home.

"We're not in favor of legalizing more certified professional midwives," said Melissa Garvey, communications manager for the American College of Nurse-Midwives. "In the United States, you should have formal training and education. The consumer doesn't know what they're getting into. We are officially pro home birth, but you should have a qualified attendant, somebody who is qualified to attend a birth."

Galvan and hundreds of other Maryland families disagree, claiming they are more than happy with services provided by certified professional midwives.

Galvan's wife, Lisa, gave birth to their 1-year-old son, Sam, in the living room of their Hagerstown home. Because of the lack of licensed nurse-midwives in the area, the Galvans contracted a certified professional midwife.

"It's a really beautiful thing when you have midwives," he said. "They truly understand where you're at the whole time."

Out of state search

Wendy Woods, of Glenarden, also had trouble finding a licensed-nurse-midwife in her area when she chose that route for the birth of her second child, Ephraim, now 18 months old. She ended up finding one in Alexandria, Va., through an organization called Birthcare.

Thanks to the nurse-midwife, who traveled from Virginia, Woods had the birth experience she was seeking: a hands-on midwife, who encouraged and aided her through the labor.

"The midwife was really good. She actually did some hand massage, which was helpful," Woods said. "And she did the moaning with me. If I didn't have someone right there, I would think it was getting a little too intense."

While some moms want midwives to rub their backs or be close by, many moms who give birth at home want more independence.

Of her clients, Dodge said that is a pretty common response, especially for experienced moms. They want to birth their babies on their own, but also have the reassurance of a nurse-midwife to help if needed.

"Women and families are empowered by taking care of themselves and letting their bodies do the powerful work of birth that they know they can do without being interfered with," Dodge said. "Our goal and our role is to allow women to go into labor as normally as possible. We are not trying to speed it up. We aren't trying to fix something that's not broken. We're observing. We're monitoring. We're assessing. Our goal is safety."