Unassisted: Home Birth in Nebraska, Part Two

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December 30th, 2011

Omaha, NE – A single line keeps Certified Nurse Midwives from attending home births in Nebraska. Some families want to see it removed; however, some medical professionals say that is a bad idea.

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[audio:http://www.kvnonews.com/wp-content/uploads/2011/12/Part-Two-Unassisted-final.mp3]

Nebraska Sen. Tony Fulton of Lincoln wants to repeal a single line in Nebraska’s medical laws: the one prohibiting Certified Nurse Midwives from attending home births. “Here’s a conservative Republican saying we ought to be progressive when it comes to home births,” he said. “A bit of irony there, but this is not a conservative/progressive thing. This is rational, common sense.This is what we should do.”

Sen. Tony Fulton of Lincoln supports repealing current state statute that prohibits assisted home births by Certified Nurse Midwives. (Photo credit Nebraska Legislature)

Fulton was approached by Nebraska mothers asking for his help years ago. The advocacy group Nebraska Friends of Midwives would visit the capitol handing out M&M cookies to legislators to remind them of “mothers and midwives.”

“For them to be stigmatized as strange or awkward, it’s the ultimate of ironies because these are moms,” Fulton said. “And often times the stigmas are being foisted upon them by those who are not moms.”

Jessica Freeman is a mother of three and a board member of Nebraska Friends of Midwives. During her first pregnancy, she said like most newly expectant mothers, she had read many books on child birth. But when it came time to deliver, she said she experienced interventions by hospital staff she felt might not be safe.

The Nebraska Medical Association said they will never support allowing assisted home births. (Photo by Robyn Wisch)

Her doctor broke her water, and told her to push, an urge, Freeman said, she never had.

“I came out feeling… just not sure what I was doing,” Freeman said. “I didn’t ever have the urge to push, you know, I didn’t have that confidence, that sense of ‘I can do this.’ And that translates into your mothering.”

That experience led Freeman to seek out a home birth for her next two children. Her first home birth was performed in New York, and despite the ban, her second was in Nebraska.

“We’re not looking for 50 percent of births to be in the home,” she said. “We’re just saying we want the ones who know about home birth, want to be able to have a safe home birth, we want to be able to have an attendant there, to make sure nothing goes terribly wrong, and to help us if something does go wrong.”

But the Nebraska Medical Association says Nebraska’s laws should stay as they are.

Nebraska Friends of Midwives at the Capitol in October for "Cookie Day." (Photo retreived from NFOM Facebook page)

“The reason that the physicians and the medical community is concerned about this issue have to do with the health and the safety of the mother and the child,” said David Buntain, a lobbyist for the Nebraska Medical Association. Any attempts to repeal the home birth provision, Buntain said, will never be supported by the NMA.

“You’re making a decision, not just for the mother, but also for that child who’s being born,” he said. “And the child doesn’t really have a say in it. And I would think the child would want to be born in an environment where he or she has the best chance to have a normal birth.”

Sarah Jacobitz-Kizzier is in her final year as a University of Nebraska Medical Center student. She’s planning to become a family physician. I asked her why she believes the medical community is resistant to allow home births. She said it’s a “fear of lawsuits, losing their own medical license, of losing prestige in their community…all these things are scary to new professionals, to new medical students.”

Jacobitz-Kizzier said in medical school, the practice of home birth is never brought up. And often, she said, the topic was “taboo” with fellow med students. She said she feels women should have as many options as they want. And she said there are widespread misconceptions about women who want home births.

Sen. Ken Haar introduced, but later withdrew, LB581 earlier this year, which would repeal the law. He plans to reintroduce in the future. (Photo credit Nebraska Watchdog)

“The one that is most polarizing and the most untrue, is the (one) that women who choose to do home births are labeled as having a stronger emphasis on the process of the birth rather than the outcome, which is totally untrue,” she said.

But the Nebraska Medical Association isn’t the only medical group against home births. The American College of Obstetricians and Gynecologists said “although the absolute risk of planned home births is low, published medical evidence shows it does carry a two-to three-fold increase.” Jacobitz-Kizzier disputes that idea. She cited a 2009 study which found there was no difference in risk for home or hospital births. That study was published in British Journal of Obstetrics and Gynaecology.

When it comes to the state’s interest, Buntain said, “The issue really is what’s best for the people of Nebraska, and the Medical Association believes that it is not in the best interest of women of Nebraska for the state to allow home birth.”

Earlier this year, Sen. Ken Haar of Malcolm, introduced a bill that would repeal the current statute. But Haar withdrew the bill to allow another by Sen. Fulton to pass without issue. Fulton’s bill made it more likely hospitals would consider hiring a Certified Nurse Midwife. Sen. Haar plans to reintroduce the bill, but is unsure if it will make it out of committee. Health and Human Services Committee Chairperson Senator Kathy Campbell said she cannot comment on potential bills, only she will have to “wait and see.”

Sen. Fulton said it is something that needs to change.

“Virtually every other state allows this except Nebraska,” he said. “Either Nebraska is going to be the safest place on the planet to have babies, or it’s going to stick out like a sore thumb.”

More:

Unassisted: Home Birth in Nebraska, Part One

21 Responses

  1. NebraskaDad says:

    David Buntain’s statement – “he or she has the best chance to have a normal birth”

    What exactly is a normal birth to this man?

    The current system in Nebraska is not set to cater to the mother or baby. The only guaranteed beneficiary of any maternal event is the OB.

    Its not just women who are outraged at the situation!

    • Birthpower says:

      Nebraska dad…
      Normal Birth according to Buntain:
      Shackled to a bed by electronic fetal monitoring.
      Laying down on your back.
      Pitocin.
      Room full of people with a spotlight on the vagina,
      Lithotomy position,
      coached purple-pushing with your legs up behind your head,
      Distressed baby & exhausted mother
      Cesarean section.
      Mother and baby separated for clean up, procedures and recovery.

      Compliant mother, surrendering to hospital policy, docilely waiting for her baby to be brought to her!

  2. Shaye says:

    <<Buntain said, "…the Medical Association believes that it is not in the best interest of women of Nebraska for the state to allow home birth.”

    Let's be clear here: Nebraska *allows* home birth. Does David Buntain not realize that? Anyone can have their baby anywhere in the state. What's *not* allowed in Nebraska is for a Certified Nurse-Midwife to attend to a laboring mother outside of a hospital.

    By not allowing a highly-trained provider to attend a home birth in our state, the Nebraska Medical Association isn't making anything safer for our mothers. To the contrary, they're lobbying to make it more dangerous by forcing families to go it alone. Remember, many of our rural mothers and families are quite far from a high level hospital, many labor and give birth very quickly, and a large number of our families have deeply held religious reasons for not entering a hospital to give birth (unless an emergency arises). If mothers are purposefully restricted from an attendant unless they make it to a hospital, they stand to lose a great deal simply by living by their philosophies and their religious beliefs. What gives anyone the right to take away this basic human right from a family (and a baby)?

  3. Jessica says:

    David Buntain says: “And I would think the child would want to be born in an environment where he or she has the best chance to have a normal birth.”

    Exactly! But where we differ in opinion is who gets to decide what a normal birth is. Is a normal birth lying in a hospital bed, strapped to machines, drugged, etc with a OB telling you when and what to do because you can’t trust your body to know what it needs? Or is a normal birth being surrounded by support and family, laboring in various positions, following the lead of each individual mother’s body, working with the baby to get it out safely?

    Women of Nebraska should be allowed to choose the location of their birth and their preferred birth attendants. Barring CNMs from attending homebirth and keeping doctors too scared to risk their professional status to consider the idea just means that women are having babies by themselves or importing midwifes from farther away to attend them, both situations which are potentially more dangerous for mothers and babies.

    Studies show that midwife attended homebirths are as safe and have outcomes as good or better than hospital births, including fewer interventions to recover from such as cesarean sections, episiotomies, etc. (Studies about homebirth which state the opposite usually have made errors in their data like including unplanned emergency homebirths without skilled attendants which are more likely to have poorer outcomes and skew the data.)

    And on a personal note: While I did import a midwife from another state, it was not from NY! Still it was an aggravating situation to be in, wondering if the midwife would have enough time to arrive before the baby did and wondering throughout the pregnancy if the midwife would still be practicing or would have run into trouble, been jailed, or worse by the time the birth happened.

    Nebraska needs more legal options for women choosing homebirth because we are educated and we know what we want. Now let us do it safely!

    • Lindsey Peterson, KVNO News says:

      Jessica:

      I apologize for the error regarding the state of origin of your second midwife. I have corrected the published story above to reflect that.

      Thank you,

      -Lindsey
      KVNO News

  4. First-time Mom-to-Be says:

    “You’re making a decision, not just for the mother, but also for that child who’s being born,” he said. “And the child doesn’t really have a say in it. And I would think the child would want to be born in an environment where he or she has the best chance to have a normal birth.”

    So this lobbyist thinks my child would want to be born in a hospital? How does he know what my child wants? I’m my baby’s mother! A “normal birth” is the natural kind that has gone on for centuries before our present time – which is not in a hospital.

  5. Jake's Mom says:

    I don’t understand…how can the AMA and ACOG and all the rest of them spout off about the safety of the baby who has now say in it? First, do they not think that moms think of this? Second, why is it inappropriate to these organizations to choose how to birth your child, but not to choose to terminate your child’s life in utero?? That baby doesn’t get a say either.

  6. Kate Bodmann says:

    The fact that only NE and Alabama won’t allow CNMs to attend home births should really say something. Even if you know nothing about the situation that speaks volumes.

    Also if the medical association is so concerned about mother and baby health outcomes they need to allow CNMs to attend home births. Since we all see the hypocracy in that stance let’s just be clear it is about monopolizing a system for profit. Also no one is going to force health providers to provide the service, there are already many lined up to do so. That is truly what they fear not negative outcomes.

  7. BriddysMama says:

    I agree with everyone’s comments. It is a HUGE oxymoron that it is ok for unassisted homebirths but not assisted ones! HELLO medical people, outlawing attended homebirths is NOT going to make women come running to your hospital! It just means that they may make the choice to go unassisted and risk the chance of something going wrong! Seeing as how Alabama and Nebraska are the only two states who outlaw it definitely says something! They are trying to hard to control their residents rather than allowing us to make our decisions and have the appropriate tools necessary! Safety in labor and birth does NOT require a hospital, it only requires a trained professional, in this case it would be allowing CNM’s to attend homebirths!

  8. NavelgazingMidwife says:

    Reading this from afar, it’s interesting that the push is for CNMs and not CPMs as it is in other states. Why is that? Mind you, I firmly believe CNMs have much more of the proper education and skills training to oversee even normal homebirths, so think it’d be awesome to have the law reflect that, but I’m just surprised the CPMs are hardly mentioned here.

    Someone from the FoM able to enlighten me/us?

    • Rachel Howell -Nebraska Friends of Midwives, Chair says:

      Hi Navelgazing Midwife! If this is you http://navelgazingmidwife.squarespace.com/ I have been to your site several times and enjoy it.

      I chair Nebraska Friends of Midwives and I would be happy to explain to you why we currently pursue CNM, rather than CPM, legislation.

      First, CPMs are not yet licensed in Nebraska. CNMs are already licensed, we “just” need to remove the home birth exclusion. Home birth attendance by a CNM is explicitly prohibited by statute- a remnant from a concession made in order to obtain licensing for CNMs in 1983.

      Second, Nebraska ranks fifth in the nation in hospitals per capita- and although it is a wonderful state in many ways, it is not altogether progressive when it comes to maternity options. Ironically, during a hearing for a bill to allow home birth a lobbyist for the opposition stated that he likes to think that Nebraska is not behind the times, but leading the way in its prohibition of midwife-attended home birth. NFOM members have come to understand that our legislators are more comfortable with the idea of CNMs than of CPMs (they are familiar with the profession of nursing), and it is easy to point to the 48 other states in which CNMs are allowed to attend home birth, including all our surrounding states.

      Third, the majority of CNMs in Nebraska want to see the scope of CNM practice appropriately expanded. Any legislation introduced to license CPMs at this time would almost certainly lack the support (at least) of CNMs.

      There are plenty of Nebraskans that would love to see CPMs practicing in this state, and who would be thrilled with the passage of HR 1054. A bill to license CPMs in Nebraska would probably make more headway in the future- and this federal legislation would give it a nice nudge.

      There is more information about the history of NFOM’s efforts on the NFOM website- check out the More About NFOM page. It is a work in progress, but there is quite a bit of material there already. http://www.nebraskamidwives.org/more-about-nfom.html

      Thank you so much for your interest in Nebraska’s efforts to increase access to midwifery care- please like NFOM on facebook and keep in touch.

  9. midwyf says:

    The UK place of birth study has recently found that in uncomplicated pregnancy, midwifery led care is safer for mothers and babies.

  10. Rebecca says:

    I liked reading the comments to the article…all were written by obviously educated, articulate mothers who feel that the medical community shouldn’t have a monopoly on where or how a woman gives birth.  I had to drive 45 minutes when I went into labor last week to make it to a hospital that would allow me to do a VBAC.  And the sad part was that I was a prime candidate for one, had NO health issues the entire pregnancy, and the only reason I had a c-section was for breech position.  I had a natural birth this time around (although I barely made it to the hospital in time….was in transition and pushing during the trip to the hospital) and the only person in L&D who was pushing against my birth plan was the attending OB.  She went so far as to try and move me from a squatting position while I was pushing into a position on my back with my feet up so it would be more convenient for her.  I got right back up on the birthing bar into my squat and refused to move.  The most pain was actually caused by her as she ran her finger up and around the baby’s head as it was being pushed out.  And thanks to her yanking on the baby’s shoulder to pull it out faster (hey she has to hurry and be somewhere) I suffered first degree labia tear. 

    The point is, the medical community is trying to pad their pockets, not protect women and children. If I ever deliver again, it will be a homebirth and thankfully I live in a progressive state which allows me to have a CNM attend.

  11. Gail Consoli CNM says:

    We finally have a birth center in Bellview…We have home birth as an option if you can get across the state line into CO, IO, KS, or SD…Of course, that is not really home birth…If you have to travel to some place to have an out of hosp. birth is it? I am just saying women in NE are having home births…that’s a fact…Shouldn’t they have to right to a safe one?

  12. trisha pearce says:

    Birthing babies at home existed well before physicians got involved in birthing – like forever in time! The woman birthing should be the person in charge of birthing location choice and should not be forced to be “in hospital” for birth. The arguments against birthing at home, although couched in “safety of mother and baby” are not based in safety evidence and are likely dollar and turf driven.

  13. Dawn Renshaw says:

    I will be graduating this May as A PNP. I am from WV but my husband is originally from Lincoln and we will be relocating there this summer. I was surprised to hear that NE does not allow homebirths, but most of the bordering states do. I believe this is once again a strugle between nursing and the medical community. It is unfortunate because CNMs are highly educated and competent providers. I would be glad to be a voice for you if needed. I am not a CNM but will be dealing with newborns and families on a daily basis, so this problem is pertinent. My current email is drenshaw@btc.edu if you want to mail me some info.
    Dawn R Renshaw RN,BSN
    Nursing Instructor of Pediatrics

  14. Alicia Donini says:

    Unless Mr Buntain has a vagina and pushes a baby out of it, I suggest he keeps his lobbying to other matters. The laws are made to protect the citizenry and the Nebraska mothers have decided how they want to be protected. They should be heard because these are voting citizens and they will die to protect their babies. I’m not a CNM, don’t know what a CPM is and I think a PNP is a nurse practitioner but I don’t hold that title either but I can tell you what I am: I am a mom of 4 children and I am a home birther and law or not, I am recommending everyone I know to get a CNM, a CPM not sure but definetely a PNP to bring their babies into this world any way they choose.
    Mr B, let the women who have had vaginas all their lives make that decision on their own. I’m very tired, sleep deprived, under paid and I just don’t need another one of you telling me what to do with my family. GROW A BIRTH CANAL and then we’ll talk!

  15. Heather says:

    I have been lingering over these articles and the audio versions for days. Thank you Lindsey for presenting the matter and sides well -nicely done.

    I’m a NE native who would delight in the opportunity to attend home births in the state where I call home…a midwife for my neighbors if they wish are were appropriate for such care. I have made the diligent drive to Lincoln since 2002 in efforts to respond not only to my professional calling, but Nebraskans -consumers- wanting option they have in so many other states…and nothing changes. Instead I hear more and more families making the decision to stay home regardless if someone is there -and I can understand, but I find it disheartening.

    I have practiced in hospitals, homes, and a birth center and there’s just something sweeter about home. If you haven’t birthed there, sincerely learned about it, or witnessed it at home don’t be quick to judge. Outcomes are good, routine & emergency equipment and medications are brought -everything you have at a birth center you have at a home birth. I split my time between NE and TX. In TX I practice as a CNM & FNP where in a 24 hour span last week one delivered at home (near bliss), one in the bathroom (most are in the tub, but standing at the sink is a fine alternative), and two transferred to the hospital for non-emergent reasons. ALL were well, born vaginally and women were given options and respected for their informed decisions -that I am proud of. One though who birthed in the hospital is missing the experience which she said was her best birth of 6 -her first one at home just across the river from NE in Iowa -legally in Iowa…the midwife practiced legally in their home (does no one understand how different NE looks?!?!?)

    Thank you Sen Haar, Sen Fulton, and the other Senators (Wallman, …& former Senators Stuthman, Erdman & Smith) who have listened to their constituents who have asked for a safer birth option -to have a licensed and trained midwife able to attend them, and to simply be respected to make their own decision

    Many thank to my friend Jeanne Prentice, CNM who boldly spoke words I echo and spoke consistently with the position of her professional organization -an example of why she got a 2011 ACNM award. I sit on the ACNM BOD and am proud that the ACNM supports women having options of birth locations and access to full-scope CNM care –including at home.

    And to NFOM members -I hear you and SO appreciate you! …off to find some M&M’s!

  16. Denise says:

    ACOG recommends that if a woman chooses home birth, that it be attended by a Certified-Nurse Midwife. Maybe the Nebraska Medical Association should consult their physician colleagues before they oppose a change in the law.

    Prove to me the safety of hospital birth before you oppose the safety of homebirth.

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