More on home birth
If you missed it last week, check out my feature about home birth in Rhode Island.
This story took a long time to produce, partially because I had a lot to learn, but also because I was fascinated by some of the finer details that couldn’t fit into a seven minute radio piece. So please indulge me while I wrote about a few of them here.
The story that aired on our station gave you a basic outline of home birth in the state- in 1988 two babies died at home, the attending midwife lost her license, and then for almost 20 years there were no RI licensed midwifes delivering babies at home. But check out this chart from the Rhode Island Department of Health. Home births still happened between 1988 and 2007. You might have to click on the image to see it better.
Look at the data for 1990- fifty home births happened two years after the only legal home birth midwife lost her license. What’s going on here?
Well, for one, not all of these home births are planned. It counts as a home birth whether you have a kiddie pool set up in the living room or you just couldn’t make it to the hospital. But that doesn’t account for all of the births. I mentioned this briefly in the piece- Massachusetts midwives were coming into the state and delivering a lot of these babies.
At the time, it was the only way Rhode Island women could get professional help with their home births. But the whole situation was very complicated- how do you coordinate care at the hospital if something goes wrong? Who signs the birth certificate?
In 2007, when Michelle Palmer started offering home births in Rhode Island, these unlicensed midwives continued to practice in the state. For some, they offered an alternative to the one and only licensed midwife offering the service, but for others it created even more complications.
Mary Mumford Haley became the sole home birth midwife in the state when Michelle Palmer moved to New Zealand. She says she tries to protect the reputation of midwives like her by being extremely cautious about what kinds of babies she’ll deliver. No babies from moms who had cesarean sections in the past, no twins, no babies in breech position, and no babies that have been in for more than 41 weeks. That’s because all of these characteristics make it more likely something could go wrong during birth.
Women who wanted a home birth but didn’t fit Mumford Haley’s specifications often went to Massachusetts midwives who had a different philosophy about what constitutes a serious risk. That makes Mumford Haley nervous. She told me-
When you’re practicing underground and you know your only commitment is to the woman… that allows you a whole lot more freedom to do what she wants. Because now she’s employing you, you’re not beholden to any other body and you’re just being with the woman. That’s different than when you want to create a practice that is respectable to the community.
Massachusetts doesn’t license its home birth midwives, so in some ways they have nothing to lose when they come into this state. Mary Mumford Haley says she knows midwives who say they wouldn’t perform some of the risky births they do if they had a license that was at stake.
But out of state midwives are often put in an odd position themselves. Mumford Haley says she knows some women so set on home birth that they claim they’ll do it themselves if no one agrees to assist them.
And on some levels that’s a threat. And I think that’s an unfair thing to do to any other human. And I know there have been midwives that are pulled over their own boundaries of safety because of that. And that’s a tough place to be.
All of this was coexisting in a messy way until the RI Department of Health decided it had to do something about the out of state midwives. It sent a cease and desist letter to a Massachusetts woman delivering a lot of babies in the state. The folks I spoke to say the move scared a lot of out of state midwives, many of whom stopped offering their services in Rhode Island. That left women with riskier pregnancies with no one willing to deliver their babies. There was talk of renting hotel rooms in Massachusetts so moms could still have a “home birth” experience, but I’m not sure if anyone actually did that.
That’s how I eventually came to this story. A woman expecting twins was so upset she couldn’t have a home birth in Rhode Island she sent me an editorial entitled “Rhode Island Restricts Women’s Birth Choices.” I’d already heard that the state only had one licensed midwife offering home births, so this added controversy was all I needed to look into this subculture.
It’s strange. On the one side you have licensed midwives offering home births who have to prove to the medical community that what they do is legitimate. They’re facing skepticism every day, especially following those deaths in 1988. On the other hand, there are women in Rhode Island who says these midwives aren’t doing enough- they should be willing to deliver twins or babies after a cesarean or what have you. The home birth midwives are either too out there or too strict.
Meanwhile, it’s nearly impossible to get health insurance coverage for home birth. That’s why the state’s home birth midwives only accept cash. It costs about $4,000 to have a home birth. My friend Beatrice McGeoch had to tangle with United Health Care for about three months before she was reimbursed for the birth of her daughter Freya. Blue Cross Blue Shield tells me it does cover home births but –
We just recently defined our policy on this topic and it is not yet down on paper, although we do currently provide reimbursements for home births. When it is articulated in hard copy, it will be available.
Will all this extra work- paying out of pocket, fighting with the insurance company, finding the one and only legal home birth midwife in the state, why do people do it? Beatrice’s husband Eric puts it this way-
This was definitely worth the cost of buying a used car… When I was born, my dad got to be in the ER room. And when she was born I literally got to be a real part of it and catch that baby on the way out. It was so powerful. Me and Freya have a really good bond and that might be part of it for me.
What do you think? Would you pay $4,000 to have your baby at home?