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More on home birth

January 23, 2012

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?

14 Comments leave one →
  1. January 26, 2012 9:52 pm

    Thanks so much Megan for covering this issue in RI . This is an issue that Is near and dear to my heart and a lot of families have Misinformation about home birth in RI .Unfortunately I can only reach a few people but thanks to media you have let many families know the truth about home birth , that it is not illegal but a safe alternative to hospital birth provided by caring respected midwives and the real reasons why they don’t perform vbacs, twins or breaches deliveries at home.

    • January 30, 2012 11:29 pm

      Thanks so much for weighing in on the topic! It took me a while to get to the facts about home birth- you’re right, there seems to be a lot of confusion about how the system actually works. I’m happy to help clarify!

  2. Natalie permalink
    January 30, 2012 11:10 pm

    On the $ note, I’m now with Samaritans Ministries (not an insurance company, you have to qualify under very specific guidelines), and one of the reasons I wanted to join them is because they will cover 100% of homebirth costs.

    Also, thank you for writing about this. There is so much confusion surrounding homebirth (I was confused for good while, so much mis-information being spread). I’m personally 100% against underground midwife practices (but don’t get me wrong, I would never rat them out), not because I don’t think CPM’s can deliver babies safely, but because it’s illegal in RI, and I don’t think anyone’s above the law. On the other hand, I’m torn, because I really prefer the birth philosophy of CPM’s. So I was one that was “forced” to deliver at a hospital (because I found the criteria of the CNM’s to be too strict as you noted), and guess what, it wasn’t the end of the world. I don’t think I’m entitled to a midwife who will deliver how and where I want; that’s un-realistic. I chose the ideal midwife in the not so ideal location.

    • January 30, 2012 11:30 pm

      Thanks Natalie! Where did you end up delivering your baby? Did the hospital offer some of the things you were looking for in a home birth?

      • Natalie permalink
        January 30, 2012 11:58 pm

        I delivered at Kent County Hospital in Warwick with Deb White, CNM. She agreed with me that I should labor at home for as long as I could, so I had many things that I had wanted from a home birth experience. I labored outside & in my house with a doula for most of it, basically got to the hospital and started pushing. After the nurses read my birth plan, they understood that I was “one of those patients” (lol), and totally respected my wishes. Nurses are hit or miss in any hospital, I was blessed to get some wonderful ones this time (this was my third time at Kent).

      • January 31, 2012 8:03 am

        Congratulations. Sounds like you got what you wanted!

  3. February 7, 2012 2:46 pm

    I’m glad you’re writing about this, Megan. Please keep on it.
    You asked if you’d pay $4,000 for a home birth. My husband and I pad for 3 home births out of pocket. Financially that was a sacrifice; physically and emotionally, it was a salvation. My 1st child was born by C-section, and the only way I could find to avoid a repeat C/s was to do my homework and find out my options. For me, that meant taking Bradley Method classes, and finding a doctor’s group that delivers at home. (this was in another state) Our last birth was here, with an excellent Mass. midwife. After 2 homebirths, I wasn’t about to go back to a hospital unless it was medically necessary. 2 of my homebirths were difficult and 1 was a breeze — but they were all so much better for being at home than elsewhere.

    I DO think insurance ought to cover midwifery costs for prenatal care and home births! Nearly all the time, you’d be saving them money!! When will they wise up and realize their precious bottom line is higher than it needs to be?

    • February 8, 2012 12:04 pm

      Thanks for reading Mimi! I decided to do this story because so many of my friends were getting pregnant and choosing to use midwives. It was great to learn more about the range of options for women in Rhode Island. I’m from Oregon, a state whose home birth practices are pretty progressive and there are loads of birthing centers. It was interesting to see Rhode Island’s approach to the same issues.

  4. Cici permalink
    March 6, 2012 7:15 am

    Thanks for your insights. I’ve been gathering information for my daughter. The question I have is this; are home births legal in RI and are midwives licensed to deliver babies for a planned home birth. I believe you answered the question, but it I want to be sure.

    • March 6, 2012 7:48 am

      Hi CiCi-

      Yes, home births are legal in Rhode Island. Right now Mary Mumford Haley and the other midwives in her practice are the only midwives in the state offering home birth services, but any Certified Nurse Midwife (CNM) or Certified Midwife (CM) in the state can offer the service if he/she chooses to. Hope this helps!

      • March 6, 2012 10:42 am

        It’s also perfectly legal to have a CNM or CPM (Certified Professional Midwife) from Mass. or Conn. catch babies in RI homes. For that matter, it’s LEGAL for anyone or no one to assist at a birth. It’s not generally advised as safe, of course, to not have a medically trained birth expert there, though.
        Some good books to read on the subject of home births are Dr. Eisenstein’s “Home Court Advantage” and (can’t remember the author of) “Safe Alternatives in Childbirth” There’s legal and safe: a midwife at home; and there’s legal and not as safe: unassisted home birth.
        I’ve had 3 home births, after 1 hospital birth, and unless you’re sick, why would you go to a hospital? There are real risks to being there. Read things by Dr. Buckley, DR> Marsden Wagner, Ina May Gaskin,, Jennifer Block, Henci Goer, Robbie Davis, Michel Odent.

      • March 6, 2012 12:01 pm

        I would just add that although midwives from Connecticut and Massachusetts DO offer home births in Rhode Island, they are violating state law by practicing in the state without a license. A MA midwife recently received a cease and desist letter from the Department of Health. So, what they’re doing is technically illegal if they receive payment for their services.

      • March 6, 2012 8:26 pm

        IAgreed. As frustrating, short-sighted, punitive and plain wrong as it is for midwives to be restricted this way, one potential loophole in the legalities for the parents is WHO is breaking the law. If the law states that the midwife is breaking the law, then the birthing mother isn’t breaking the law. (Of course, the midwife wouldn’t be hired to catch the baby if the mother hadn’t hired her.) But, still, I wonder whether that implies wiggle room on the legality issue.

        It’s ridiculous and dangerous for midwives to be treated this way by the law (pushed into law by the powerful AMA lobbyists). The research is clear that countries where midwifery is the norm have fewer infant and maternal mortality rates, and better outcomes overall. When midwives are limited and harassed as they are in America, we all lose. We lose options, we lose wellness, we lose lives. And that’s due largely to greed and arrogance from the US medical establishment, particularly the AMA and the College of Ob-Gyn.

  5. Natalie permalink
    March 6, 2012 2:28 pm

    Megan is correct, and the CPM’s providing these services in RI know it’s illegal. The law is clear about it, but so many people think it’s legal that it’s spread around “underground” so to speak, and people don’t take the time to check the law and what it actually says. You have to be licensed in RI and be a CN or CNM. Unassisted birth is of course legal but that’s a whole different story. http://www.homebirthri.org/about-home-birth-ri/

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