Updated: Jun 12, 2020
Today I’m going to be talking about homebirth, specifically homebirth as it is in Nebraska, where I live. If you are a woman living in Nebraska and you’ve had a homebirth or you are just curious what homebirth is all about please keep listening! If you live in a different state I do talk about general homebirth topics to think about.
Most people know that I am a huge advocate for women being empowered and making the choices that are best for her and her family. Current situations in Nebraska have brought to light how many women are begging for choices but don’t have them. I am blown away by the amount of women who want a homebirth or at the very least were interested in a homebirth but then heard a multitude of reasons for everyone around her why she shouldn’t. I want to use this time to discuss the importance of changing the law in Nebraska to openly accept all types of midwives so that the options for women can expand. Hang on until the end because I do have a call to action for those of you who are ready to fight for change. You deserve choices. This is NOT just for women who want to birth at home this is for ALL women who believe that limiting options for women is NOT an option!
Here is a little history on how Nebraska became an unfriendly place to practice midwifery:
Then Attorney General, Don Stenberg, in 1993 issued a statement that in his opinion it was illegal to practice midwifery in the State of Nebraska. (1) This has had a strong bearing on the perspective of lawmakers in this State. Since that point in time midwives have been encumbered with the definition of “practicing medicine” that is applied to their services. They have been pursued with litigation and become reluctant in offering their services to Nebraskans. Consequently, families have been denied their right of accessibility to these services.
1. The state of Nebraska is known to be very hostile in women making a choice for where she wants to birth. Currently the the law in NE is Statue 38-613 (3) states:
A certified nurse midwife may perform authorized medical functions only in the following settings:
(a) In a licensed or certified health care facility as an employee or as a person granted privileges by the facility;
(b) In the primary office of a licensed practitioner or in any setting authorized by the collaborating licensed practitioner, except that a certified nurse midwife shall not attend a home delivery; or
(c) Within an organized public health agency.
At this time it is a felony for Certified Nurse-Midwives (CNMs) to attend home births in Nebraska. Despite the fact that the attendance of home birth is within the scope of practice of a CNM, Nebraska is the only state to outlaw the practice of CNMs in this prospective location, So homebirth is legal. The unfortunate thing is that women who want to homebirth have limited options. Either they free birth without a midwife or they have to search for a traditional midwife of Certified Professional Midwife to attend. This is no easy feat as CPM’s and traditional midwives have been prosecuted by our state in the past. Do you see, by not giving women an option on who can attend her birth you are making it more dangerous. Women deserve to have someone attend that THEY chose who is experienced in physiological birth to attend. There is no continuity of care, there is no respect for theses midwives who are thoroughly trained in physiological birth and then if a transfer does happen the woman is belittled and treated as if she did something completely reckless. Women who choose homebirth do not go into it lightly. They have to overcome some major cultural boundaries as well as built in beliefs about birth before committing to birthing at home.
2. The beliefs surrounding birth needs to change. Birth is not a medical event. Let me repeat. Birth is NOT a medical event. This is a normal and natural process that bodies know how to do MOST OF THE TIME! When physiological birth isn't happening as it is supposed to then that is when it becomes a medical event and where hospitals and physicians are appreciated. As long as people believe birth is a medical event the choice for homebirth will be limited. Since birth is not a medical event, any woman who is attending a birthing woman in her home cannot be prosecuted for practicing medicine.
3. Licensing is not the answer. By licensing midwives you are limiting options for women. Having a license that is regulated by the state doesn’t make you a “better midwife” it just makes you a regulated midwife. By all means, choose to have a licensed midwife attend but know that they are regulated by their licensing agency. For example, CNMs are regulated by the facility they work for. So if a woman would like to VBAC with a certain CNM but the facility this CNM works at does not allow VBAC the woman would have to go somewhere else. You see, this is limiting women their options. So now the woman can choose to freebirth or go to a hospital with a doctor or midwife she doesn’t have the same opinions about birth. By limiting midwives you limit women’s choice.
4. There is no such thing as a “safe” birth. Birth is unpredictable. Things happen whether you are at home or in the hospital. There is no way to make birth 100% safe for the mother or the baby. This is why the woman has the responsibility and the right to choose what defines her risk. Not her provider. For example, having a previous c-section automatically labels you as “high risk” in the hospital. If having a homebirth is only for those who are “low risk” you would not qualify for a homebirth. That is only if you let your medical provider define your risk. This is where knowing all of the risks and benefits of your decision matters. You can choose to define if having a homebirth after a cesarean is too high of risk for you or not. If you decide that homebirth is for you then you can then search for a certified or traditional midwife who is willing to attend. There is risk no matter where, when or how you birth. And anytime a mother or baby die it is a tragedy. Unfortunately, death is a part of life. Currently in the United States we rank 10th out of similarly wealthy countries in maternal morbidity rates. Right now 17.4/1000 mothers die from childbirth complications. 5.7/1000 babies die per year. Given the fact that homebirth only accounts for 1% of birth you can see where the majority of death is happening. https://www.vox.com/2020/1/30/21113782/pregnancy-deaths-us-maternal-mortality-rate
5. If we had continuity of care women and their babies would be safer. Once midwives are finally respected and trusted as being expert in physiological birth then continuity of care can begin. When midwives feel free to refer and transfer a patient when it starts to become a medical problem women and their babies will be safer. Instead of the midwife fearing being prosecuted and postponing the transfer they will be able to freely call for an ambulance, attend the woman on the way to the hospital, give a report to the doctor and seamlessly pass care on. Instead transfers are being delayed and communication between midwives and doctors are being confused. We see this evidenced in Europe. Homebirth is safer there because there is a system in place to promote continuity of care and midwives are respected as being knowledgeable in birth.
6. It all comes down to a woman's choice and informed consent. A woman deserves to know all of the benefits, risks and alternatives of an option. She should be encouraged to follow her intuition and choose where, when and how she births. No one cares more about the safety of her baby than the mother does. A mom who chooses homebirth is not reckless. She has most likely researched and thought of all the risk and benefits before making her choice. She too has planned what the nursery is going to look like, picked out names, had the normal prenatal visits, made sure to eat healthy and planned for their future. We need to trust mothers. Believe mothers. We love our babies and would never intentionally place them in danger.
What do we want?- We want better laws! We want laws that give women more freedom of choice. We want laws like in KS and MN where birth is not legally classified as a medical event. Woman have the freedom to choose OBGYN’s, Certified Nurse Midwives or Direct entry midwives (CPM’s and Traditional). Again, please hear me! I am not saying every woman should homebirth! I am saying every woman should have the right to choose homebirth! You may not think that this is an option for you now but maybe in your future your mind will change. Maybe your daughter or granddaughter will like to have this option. This isn’t going to happen by just sitting around and wishing it to come to be. It takes a lot of work and organization. It takes talking to people who can change laws. It takes speaking and educating woman in their right to choose. It takes woman who homebirth or want to homebirth, to find their power, step up and speak out! It takes money. We need money to hire a lobbyist who knows how the legal system works, the language and how to pass laws through.
We need women who are ready to have a conversation about the option of homebirth and who we can choose to attend. Some action steps:
Contact your senators and representatives and tell them that you want more options! Call them. Email them. Tell them you want don’t want birth to be defined as a medical event anymore. Tell them you want choices on whom you would like to attend. Tell them by making all midwives be licensed they are restricting a woman's choice. We do not want that!
Be a voice! Talk about this. Share this video. Let women know they have options and by restricting midwifery you are restricting a woman's right to choose.
Stay up to date! Get involved and find your community over on our private Facebook group, Nebraska Birth Choice Advocates.
Let’s keep this momentum going, demand the change!
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