Midwife or OB? Homebirth, Hospital, or Birth Center? Factors to Consider

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Midwife or OB? Homebirth or Birth Center? For mom's seeking a natural, intervention free childbirth these choices can be daunting and the considerations that go into the decision making process vary widely based on location and individual circumstances, but they often boil down to a few general categories: Safety and comfort; Cost; and Availability and Logistics.

If you are just starting out in your search for information, I recommend the book The Thinking Woman's Guide to a Better Birth by Henci Goer. It is a thoroughly researched book that presents pros and cons of many different aspects of childbirth. It goes well beyond the simple questions of Midwife vs OB and Homebirth vs Birth Center to investigate various individual birth interventions and interactions to allow you to make informed and detailed choices. Electronic fetal monitoring? Why or why not? Pitocin? When it is necessary and when it is not. When homebirth is safe and when the hospital is safe. And so on. And since it is important to make these decisions as early as possible in pregnancy, I recommend this book as soon as you consider trying to get pregnant.

I devoured The Thinking Woman's Guide to a Better Birth along with a whole stack of books and a slew of websites during my first pregnancy and determined that for me - a fit, healthy woman experiencing a normal, low risk pregnancy - completely intervention free was the way to go. I also decided that I liked the midwifery model of care much more than the medical model of care (in short, the midwifery model assumes birth is a natural body process and focuses on support where the medical model assumes birth is a medical emergency in need of treatment and cure - this is really oversimplifying it, check out the link for more info).

Safety and Comfort

Being on active duty with the Marine Corps at the time, I found out that THE ONLY childbirth my insurance would cover was one performed my Navy doctors in the hospital of their choice. So I figured I would just work with the Navy docs and see about having an intervention free birth in their facility. No go. I was told in no uncertain terms that regardless of what I requested or said, regardless of whether I gave or denied consent, regardless of any of my wishes or desires, regardless of whether it was medically necessary, the Navy docs would give me whatever drugs they wanted, use whatever machines and interventions on me they wanted, and give me whatever birth was easiest for them.

So MacGyver and I chose to give birth outside the hospital with midwives. I really felt like it was my only viable choice since the doctors were quite literally threatening to inject me with drugs I didn't want or need against my will - drugs that would cross over to the baby. We had a wonderful homebirth with Flintstone, attended by two skilled midwives - one a certified nurse midwife, or CNM, and one a certified professional midwife, or CPM, with over 15 years experience. If we still lived there, we would absolutely go with GeorgAnna from Savannah Midwifery again. We would definitely plan another homebirth.

Here in Michigan, the decision is more complicated and more difficult. And they are decisions we need to make as soon as possible. I keep starting and stopping. I contacted some midwives. I did some research. Then I got buried in my work. Midwives book up in a way hospitals don't, so if we decide to go with midwives, we need to decide soon!

Midwifery in Michigan is not nearly as well regulated as it is in some other states. Michigan only licenses and regulates CNMs. There is no licensing or regulation for CPMs, direct entry midwives, or lay midwives (read about types of midwives). This is a problem since the majority of midwives who perform homebirths are not CNMs. CNMs, especially in this area, work almost exclusively for hospitals. Why does licensure and regulation matter? While it may seem obvious that you want licensing and regulation for standard safety measures, the issue goes beyond that.

I can do my due diligence and research CPMs. I can interview them and find out how many births they've attended, where they've trained, whether and how they are insured, and what sorts of difficult births they've attended. I can find out what their hospital transfer protocols are and have standards set in place. But a lot of it is on the honor system in unregulated and under-regulated states. I may not find out whether or not my midwife has been involved in the loss of a child. Whether she has ever been accused of negligence.


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