Unassisted: Home Birth in Nebraska, Part One


December 29th, 2011

Omaha, NE- Birth is big business to a healthcare industry that welcomes over four million babies in the United States each year. Hospitals are reinventing themselves to create an atmosphere catering to a woman’s evolving needs. However, some Nebraska women want to take their business out of the hospital altogether, but find their choice may not be a legally viable option.

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Methodist Women’s Hospital, which opened in 2010, sits just off the interstate in Elkhorn. The modern, two-building facility is a “one-stop shop” for women’s health. Women-centered facilities are not a new concept in the health care industry, but resorting back to a more home-like and natural birth experience is. Vice President of Methodist Women’s Hospital, Sue Korth, took me on a tour of the hospital’s new labor and delivery rooms. Korth said they are as “home-like” as they can get.

Methodist Women's Hospital located in Elkhorn, Nebr. (Photo courtesy Methodist Women's Hospital)

“When we did construction, the construction staff called this the “baby garage,” said Korth as she opened up closet doors revealing a baby warmer, anesthesia carts and other delivery equipment. Most equipment is hidden throughout the room behind doors, drawers and paintings to keep out of view from the patient and their guests. Soft music played above as we walked through rooms that looked more like a hotel suite, rather than a delivery room.

Korth took me to an open room with a jacuzzi tub. She said moms feel more comfortable laboring in water.

Korth said a lot more women are asking for natural birth plans lately, meaning births with limited medical interferences such as epidurals, labor inducing medications, and cesarean sections. After our tour, I asked Korth about the most natural of birth plans: the home birth.

“We feel like we’ve done a very good job as getting as close to that as we possibly can,” she said. “I think this is just the absolute safest place to be.”

Delivery rooms at the new Methodist Women's Hospital were built to feel more like home, and less clinical. (Photo courtesy Methodist Women's Hospital)

But, there are some Nebraska couples who feel a hospital will never replace the comfort of home. I spoke with “Katie” and “John”, an Omaha couple who asked we change their names to protect their identities.

“I’m terrified of hospitals,” laughed Katie. And she knows hospitals, Katie works at one in Omaha and her husband, John, is a paramedic.

“It’s just an uncomfortable environment, I think,” she said. “From the bed you’re in, to the room that you’re in, to multiple people coming in and out, in and out, not necessarily telling you what they’re doing or what’s going on—they’re just doing it. It’s just so impersonal…I’m just afraid of that.”

The couple is not expecting just yet, but is looking at their options. They prefer an assisted home birth with a Certified Nurse Midwife, but they will face some difficult choices in their planning. The birth experience they want is also an illegal one. Nebraska is one of two states where an assisted home birth attended by a Certified Nurse Midwife is prohibited. Alabama is the second.

Katie fears the professional and personal implications of having a home birth.

“I would fear for my job if I had a home birth,” she said. “But it is scary, the thought of doing it, not just my job, but with my family and society and the view of what that means.”

John said he’s also unsure of the professional implications he could face. He hasn’t told any of his paramedic instructors about their plans, but only one co-worker because he said he trusts her.

John’s professional experience may allow him to legally deliver a baby himself, either as a father or as a paramedic. If they do decide on a home birth, he said, he would have an ambulance on standby.

“There’s that gray area,” he said. “I could easily say ‘She went into labor! We had no choice but to deliver at home!’ and no one would think anything else, you know?”

If Katie decides on a home birth, it would be difficult to find a Certified Nurse Midwife willing to help. The penalties for an attending midwife can range from license revocation to jail time.

WomanKind Midwifery is owned by CNM Jeanne Prentice, who assists women from South Dakota, Wyoming and Nebraska with home births. (Photo courtesy Jeanne Prentice)

That has some Nebraska women coming to Jeanne Prentice. Prentice is the owner of the WomanKind Midwifery, located in the town of Spearfish, South Dakota, minutes from the South Dakota-Wyoming border, and nearly 600 miles from Omaha.

She never delivers in Nebraska, but says Nebraska mothers from as far southeast as Lincoln drive hours, or days, to see her. She said these women are “desperate” to have a different type of natural birth.

Speaking from her office in Spearfish, Jeanne said, “They want a different experience, they don’t want to be induced, they don’t want an epidural, they don’t want to be flat on their back with a monitor. They want something different. They want that personal care. And they can’t get it in their home state.”

Prentice said the atmosphere that compels women to drive hundreds of miles can never be replicated in a hospital setting. Hospitals are meant to treat disease, she said, something she sternly added pregnancy is not. And as for the new home-like atmospheres, Prentice isn’t buying it. She feels hospitals are quick to perform interventions, sometimes unnecessarily, breaking the tranquility of an otherwise quiet room.

“You can put nice Pergo floor in and you can hide your equipment, but the minute things look a little or feel a little scary to you, you drag that stuff out,” she said.

Not all Certified Nurse Midwives feel the same about attending home births. Prentice had strong words about midwives who support the current statute which outlaws assisted home births in Nebraska.

Prentice said women travel far for a "different" kind of birth option. (Photo courtesy Jeanne Prentice)

“Shame on them! Shame on them, that they would rather see women deliver unattended than allow another nurse midwife to provide that care,” she said. “I’m disgusted.”

Back in Elkhorn, Certified Nurse Midwife, Marilyn Lowe is one of four CNMs who make up Methodist’s new Midwifery Department. Lowe says a natural birth doesn’t have to take place outside of a hospital. After a full day of seeing patients, Lowe spoke with me after hours in her office.

“Birth is a philosophy,” Lowe said. “And it can be as natural in a hospital as it can be in a home. Our goal is to help that woman accomplish what she wants to accomplish.”

“We also have patients who want epidurals,” she said. “But if somebody wants a natural birth, that is our goal to help them accomplish that with as little intervention, but yet knowing if we need that intervention, it’s available.”

Safety for the mother and baby, Lowe said, is best found in a hospital setting.

“I’ve been an O.B. since 1978,” she said. “I’ve seen a lot of things happen very quickly, that … we had to act on we had, maybe, eight to ten minutes. If you’re outside an institution, eight to ten minutes is your travel time. To me, it’s a safety factor.”

But for Katie and John, not having the option of an attended home birth leaves them feeling unsafe and frustrated. Katie is perplexed at the notion that they can deliver themselves, but not with a trained professional.

“For me I want to have a home birth, but I don’t wanna just be by myself at home popping out a kid,” she said. “What if something goes wrong?”

“My biggest frustration is that I can have a home birth, me and my husband can have our kid at home, but we can’t have somebody who’s trained to be there with us.”


Unassisted: Home Birth in Nebraska, Part Two

61 Responses

  1. lisa says:

    What a backward state! How dare they mandate where and with whom a woman can give birth.

  2. Vanessa says:

    Thanks for this article. I can relate, because after two hospital births, I was fed up with the hospital setting, and chose to give birth to my third son at home Unassisted. Yes, part of this decision was the fact that we are in Nebraska and our options for someone to attend a birth at our home are almost none. However, we still felt that the safest and best place to give birth to our baby was at home, medical attendant or no medical attendant.

  3. Meredith says:

    SHAME ON YOU NEBRASKA!!! Women should be allowed a homebirth if they so choose, without it being a liability!

  4. kristi says:

    I wish this article would have mentioned “The Midwife’s Place.” It’s a birth center that JUST opened in Bellevue with CNM, Heather Ramsey…Meredith, we hear you…this birth center is a BIG step in the right direction!

  5. Andrea says:

    Because my second homebirth was in Nebraska where midwives are illegal, it was unassisted, so I would have felt uncomfortable doing this had the hospital not been literally two stoplights down the street. The legislation needs to change. I understand the rights of the infant if there are complications override the rights of a woman to birth at home. But statistics show that midwife-attended homebirth is just as safe if not safer than hospital births, which renders this legislature irrational.

  6. Holly says:

    I had my first child in NE at home with an underground midwife. It was a wonderful experience, but the excess strain it put on my family worrying about the legal issues and the “social acceptability” was just plain unnecessary. I now live in another state with excellent laws for midwifery, and have had another home birth here. Here it is a normal, acceptable thing for people to choose, and you can look up more than a dozen midwife practices on the computer in just moments. If home births were so dangerous, why would the many states who have supportive laws not have banned it? The truth is, in Nebraska it has NOTHING to do with safety, and EVERYTHING to do with business, and let’s not pretend the “wise” legislators there care so much more about the health of women and babies than every other state. B.S. Families need to speak up and demand

  7. Holly says:

    (sorry, comment sent too soon)
    Families need to speak up and demand that the State and the medical industry get OUT of the way and let the decisions of birth belong to the MOTHER.

  8. Erica says:

    Where are these hospital CNM’s coming up with their statement that hospitals are safer than home? The American College of Nurse Midwives has issued a position statement that says women have the right to make an informed decision about where to birth their baby. I think it is “interesting” that these hospital midwives have chosen to oppose their professional organization and collegues .

  9. Michelle says:

    Erica, the CNMs in Nebraska are forced to say these things. the OBs that overshadow them have created a Gestapo-like environment where the CNMs have to do as they say, how they say it in order to keep their jobs. Until some newer legislators with backbones come into office, who aren’t bribed by the Nebraska hospital association to vote against any home birth legislation, nothing will ever change. This has nothing to do with safety. its about money, and its about power.

  10. Elizabeth says:

    Way back in the 70s I thought there was a sea change occurring in regard to birth practices. I had my first child in the hospital and was so traumatized that I had the next two at home. Comfortable, relaxed, beautiful, fulfilling, loving, nurturing. I was so hopeful about the future for all laboring women. But here I am nearly 63 and the sad fact is that things have gotten worse. There are hospitals that will ONLY do a Caesarean delivery. Doctors are not allowed to deliver breech babies vaginally. Hospitals still have women birth babies on their backs. Episiotomies are still the norm, despite documented evidence that a cut takes longer to heal than a tear. I could go on and on. But I’ll close with this comment: Giving birth is not a medical emergency.

  11. Chuck & Diana says:

    My wife and I had 2 babies born in a hospital and in both occasions it was the wrong choice, the hospital personnel would come in about every 10 minutes and insist that my wife have pain meds and each time she would say NO. Well after a few hours of this my wife gave in and say I will if it will shut you up, so the nurses checked her and almost 15minutes later showed back up and without checking how far along my wife was just gave her the meds, well she was already at 9cm and everyone knows at that point you don;t give anything. Keep in mind this happened 2 times over 2 1/2 yrs, both of my oldest boys were born all doped up and had to be given Narcan to counter act the drugs they gave my wife. Well our last 3 births were at home our 3rd birth was assisted by a Midwife and the next 2 were not she never made it in time as she lives 2 hours away and my wife now delivers so fast we would have never made it to the Hospital which is only 5 minutes away hitting both red lights. So it was just the 2 of us and our older kids and let me tell you it was the best and most incredible way and we wouldn’t have had it any other way. We are currently expecting our 6th child and we do have the same Midwife who we really LOVE and feel as a member of our family, we all know she will most likely not make it in time for the delivery and we have planned on it and made all the necessary plans for this to be the way it will happen. I had emergency medical training in the Military and have delivered all of our 3 home birth’s and yes we know that not every birth is the same BUT we are ready for whatever happens. These two states that do not allow home birth need to wake up and let women have their way with how they wish to have their baby it isn’t like the State would or could be held accountable if something would go wrong, it pains me to think that in today’s world that we can’t have things such as home birth as a viable way to have our babies time and time again it has been proven to be as safe if not safer than in a hospital.

    • Valerie says:

      I had my first two at home with an underground midwife, my next two at UNMC with the midwives there (wrong decision) my next two I had at home also. The midwives at UNMC are fine, but it’s NOT a HB. Then a couple of years ago a friend of mine had a baby with the midwives at UNMC. I won’t name names, but it was a TERRIBLE experience for her, her sis another friend and I. The midwife when she was basically at 10cm just gave (without asking and she had been un-medicated until then) her meds which didn’t seem to help her, but made the baby have breathing issues after she was born. Three minutes after the baby came, she was already trying to pull the placenta out (yes, she had already cut the cord for no reason). She ended up yanking the cord off and then pulling the placenta out piece by piece because she was tearing it apart (just wrong besides being painful). Then after all this trauma besides to not let her rest which we had suggested, but started to stitch her up and she was so swollen the the meds weren’t working. To say the least I will NEVER again suggest the midwives there to anyone. Have a Home Birth!
      P.S. My two friends and I ended up submitting separate letters to the “Head Midwife” there and I hope that she was disciplined properly. We found out at her 6 wk. check that the midwife had lied on the medical record about the meds and the placenta.

  12. Rosey Smart-Vaher (Sth Aust) says:

    Womon Deliver others CATCH as she pushes the Baby into their Hands.
    People who Care are Covering Arse Retaining Employment – so be keep away from those who CARE. Rosey Midwife

  13. Shannon says:

    I agree with Erica, it IS unbelievable that these midwives are in direct conflict with their colleagues at The American College of Nurse Midwives. It’s obvious that Nebraska needs some CNM’s in the state with the backbone to not put up with the bullying. BOTH the CNM’s and families are going to need to make their voices LOUD and CLEAR for any sort of change to happen. Let’s get with it nebraska midwives – speak up for these families on what all the benefits of having a CNM attended home birth are!! The government needs to hear from you!!!

  14. Rachel Howell -Nebraska Friends of Midwives, Chair says:

    This series by Lindsey Peterson provides needed insight into the ongoing power struggle that exists over birth in Nebraska. Many CNMs in Nebraska support a legislative change to allow CNM attended home birth, but their voices have been effectively silenced by the legal requirement for written practice agreements with physicians. There have been and continue to be consumer-led efforts to remove the home birth exclusion from the statute governing CNM practice in Nebraska. To read about those legislative efforts, please check out nebraskamidwives.org. The pages “Home” and “More About NFOM” explain work done to modernize midwifery laws, while the page “Nebraska Midwives” informs about home birth at this time. Additionally, “Piece of the Past” gives insight into the history of midwifery in Nebraska- it is unique compilation of information gleaned from primary sources. Nebraska Friends of Midwives is also on facebook- please feel welcome to say hello!

  15. Stephanie says:

    “…If you’re outside an institution, eight to ten minutes is your travel time. To me, it’s a safety factor.”

    And disallowing access to a trained professional at home is NOT a safety factor? So much beating around the bush and circle-talking rather than supporting the option of home birth. Makes me sick.

  16. Shanna says:

    I honestly do not understand why Nebraska chooses to restrict aid to women who choose a home birth. In my opinion, allowing trained professionals to assist women in the home is a wiser choice than forcing women to have an unassisted home birth.

    I also do not understand the “cease and desist” orders that went out to various midwives over the past decade. Why are we intent as a state to diminish access to care in all settings? Why are we the only state along with Alabama to have such a backward view of home birth? How is it that in the more (so-called) “liberal” Midwestern states (such as MN, WI, & MI) women have more freedom when it comes to this issue? Why are we as a conservative state so restrictive? Why is our government so paternalistic? Conservative and paternalistic–is that not a contradiction?

    Women will have home births whether it is supported by the government or not. They will have them whether or not there is a provider to care for them during labor. If we truly want to protect women in Nebraska, we will allow trained care providers to assist women in a home birth setting.

  17. Amy Tuteur, MD says:

    Many people are unaware that there are two types of midwives in the US, certified nurse midwives (CNMs) who are comparable to the midwives of Europe, Canada and Australia, and certified professional midwives (CPMs) who exist in no other first world country.

    In contrast to CNMs who have college and masters degrees and extensive in hospital experience, and European, Canadian and Australian midwives who have college degrees and extensive in hospital experience, CPMs are high school graduates who have completed an certificate training program, many by correspondence course.

    CPMs do not do not meet the education and training standards of midwives in the Netherlands, Great Britain, Canada or Australia, or anywhere else. Indeed, American homebirth midwives (CPMs) do meet the standards for licensing in ANY industrialized country in the world. Simply put, they are “birth junkies” who couldn’t be bothered to get a real midwifery degree.

    Not surprisingly, their death rates are appalling. The most recent data published by the CDC shows that planned homebirth with a non-nurse midwife has a neonatal death rate that is more than SEVEN TIMES HIGHER than comparable risk hospital birth.

    The Midwives Alliance of North America (MANA) has collected statistics on the safety of 24,000 planned homebirths. While collecting the data, they promised it would demonstrate the safety of homebirth. Now that they analyzed it, they refuse to release the death rates. Even MANA knows that homebirth kills babies; they just don’t want American women to know.

    • Lauren says:

      “Dr.” Amy, busy yourself with something other than SCARE TACTICS why don’t you? After all you went to college!

      • Candace says:

        Tell that to people with big families such as mine who’ve done it many times over at home safely. In fact, my last one (in the hospital) was born so fast and healthy by the way that dad almost caught him because the nurses ran around like chickens with their heads cut off because my midwife was with another woman pushing! He did it better than 3 nurses with bachelors degrees because they did not want paperwork or liability issues. Mental note: catch a baby and you wont have liability issues. My boy couldve had a birth injury had my husband not been there. NEver again for me a hospital birth! The WHO also says the US c-section rates should be lower. The rate it’s at is unhealthy.

    • MJ says:

      How EVER did the human race survive without hospitals and MD’s like you?!

      ‘…homebirth kills babies…’ WOW.

      It must be disappointing that you paid for an education, yet seem so ignorant. Not that it’s your fault. How you think is directly related to what you were taught in medical school. Doctor’s fix illnesses, and pregnant women come to doctors to help them have babies, so naturally, you treat it like it’s an illness. Pregnancy and birth is not a ‘problem’ to solve. It’s as normal and natural as the grass being green and water being wet.

    • kristi says:

      YES, Dr. Amy…IF your information is accurate, then you’ve argued beautifully to show WHY Nebraska needs CNM’s to be able to deliver at home births instead of untrained midwives! Glad you agree!

  18. Kitty Ernst says:

    Looks like the Nebraska Media are finally giving some attention to what is perhaps the most importamt event in anyone’sife: the birth of a child and the beginning or building of a family. Congratulations!

    Care in the childbearing year in The United States needs long and continuous reform. We have had a century of an approach to birth based on the authoritative pronouncement by professors of the emerging specialty of obstetrics early in the last century that,in the debate over “the midwife problem” successfully made the case against midwifery that childbirth was a pathological process for the majority of women. It was asserted that, “If the profession would realize that partition viewed with modern eyes is no longer a normal function, but that it has imposing pathological dignity, the midwife would be impossible to even mention.” (Midwifery and Childbirth i America – Judith Rooks). Unlike the parallel development of the midwifery and obstetric professions in other industrialized countries and contrary to evidence of safe care by early practicing midwives, midwifery in the United States was almost eliminated.

    As the shift from home to hospital progressed and the obstetrician/surgeon became the dominant authority in the care of all childbearing women, routine medical intervention in hospital care for normal birth escalated. Women were often heavily sedated and, unable to “give birth” were delivered by forceps. It was not uncommon, under the influence of these drugs for them become agitated during their labor and require application of a camisole (straight jacket) or be tied down with bed restraints. Three exceptions, demonstrating significantly better birth outcomes by nurse-midwives, were the Frontier Nursing Service in the remotely rural mountains of Kentucky, Maternity Center Association serving disadvantaged women in New York City and Catholic Maternity Institute serving the Hispanic population surrounding Santa Fe, New Mexico. These services helped to preserve the practice of midwifery and developed the beginning of nurse-midwifery practice and education in the United States. It was at Frontier that this author, observing the labor of a strong mountain woman with her family in their one room cabin and under the care of nurse-midwives, learned the empowering difference between “giving birth” and the “being delivered”learned as a student nurse in the 40s.

    It is time to move on from the two main causes of the situation – fear and control. We know that fear leads to contol and the media has helped to generate that fear – promote confidence instead of fear, self responsibility instead of control. Shift the focus to the growing volume of scientific evedence (not authoritative pronouncements) that overwhelmingly supoorts what the women of Nebraska are seeking. Over 1/4 centru ago that evidenc said that “women should choose their place of birth” for it is essential that she feels comfortable and safe. Decorating a hosputal room is NOT cutting it. Way back in 1956 a nurse-midwife and socialogist asked women what they wanted. Simpoly stated, Information on pregnancy, a sustainig presence in labor and their abay with them after the birth. We still do not meet these sinple basic needs in our hospitals today. I’m sorry, but if a hospital wants to redecorate, start with a double bed that the family can snuggle up in after the birth. The bed in the picure was designed for the caretaker.
    Lastly, all professionals are products of their education. Under the new reform act the driving force is for evidence-based practice. That starts with revamping the education of nurses doctors and the public at large. Visit this site for a look at what could be.


  19. Jennifer says:

    Oh Amy, how nice to see you’ve made your way to NE, thanks for coming! I’m not sure what your rant was about though since we’re talking about CNMs assisting homebirth in NE, not CPMs or DEMs or LMs. NE is one of 2 states where it’s illegal to have CNMs attend homebirths, which you seem to think are capable and able to do so so thanks for supporting out cause!

  20. Shanna says:

    May I respectfully say Ms. Tuteur, that painting home birth advocates as ignorant (i.e. not knowing the difference between a CNM vs a CPM) is hardly a respectful way to get your point of view across (also, caps do not display emphasis, but actually indicates shouting. While I’m sure that is not what you intended, that is how it reads).

    You use statistics from the CDC. Do you have links to the original study?

    Also, I think we have established that women will have home births–whether the government is fine with it or not. Now, we can choose to meet women where they are at and close the gaps–increasing safe outcomes for mother and child or we can continue to bicker on the safety of home birth. If you do not care for the training of CPMs, that is fine, but instead of bashing home birth–then become part of the solution! You respect CNMs…then support the right of CNMs to assist women in the home! Let’s work on solutions together.

    Again, women will have home births…just a fact. We can choose to work together for the health of women or we can choose to fight one another. Either way, women will still have home births assisted or unassisted.

  21. Amie. says:

    It is wonderful that their is a hospital in NE that set up to facilitate natural childbirth. This is a perfect option for some families, it is what they would most be comfortable with. I am in support of any situation that encourages a mother to do what her body knows best to do. There is nothing like a homebirth though, it is an amazing experience. NE should find a way to support women and families that want to make that choice in a safe way. It is very sad that birth has become something so surrounded by fear.

  22. Amy Tuteur, MD says:

    Contrary to Ms. Ernst claims, the scientific evidence on homebirth is quite clear. ALL the existing scientific evidence, as well as state, national and international statistics shows that homebirth increases the risk of perinatal death. The only people who appear to be unaware of that are homebirth advocates themselves.

    The same CDC data that shows that homebirth with a non-CNM midwife has a neonatal mortality rate severn times higher than comparable risk hospital birth also shows that homebirth with a CNM has DOUBLE the risk of neonatal death as hospital birth with a CNM.

    It is ironic to see Ms. Ernst invoke “evidence-based practice” when virtually nothing about homebirth midwifery is supported by scientific evidence.

    It is important to realize what is at stake here: Every woman ALREADY has the right to give birth at home. Every woman ALREADY has the right to surround herself with whomever she chooses during a homebirth. The only thing that is at stake here is the right of midwives to be PAID for attending a homebirth, nothing more.

    In my judgment, midwives have no right to attend homebirths, let alone get paid for them, unless and unti they are honest with women about the real increased risk. There is simply no question that homebirth increases the risk of neonatal death (at least double, and probably more). If women wish to choose that increased risk of their baby dying, that is up to them. However, informed consent means that women must be INFORMED. As long as homebirth midwives continue to hide the increased risk of neonatal death at homebirth, no woman can make an informed decision to choose it.

    • Candace says:

      If there is increased risk for women in homebirths that midwives should make women aware of as you point out then wouldn’t a hospital be safer and the hospital need less equipment. Instead all rooms are set up in case. Now, critical thinking here, if a hospital was safer than they shouldnt need those instruments NOR have an unhealthy rate of c-sections as the WHO points out! You realize you are saying this to people who’ve more than likely had safe homebirths themselves or taken a part in one whether they are born at home, fathers or grandparents and advocate for it because theyve seen the benefits and better outcomes.

      • Dierdre says:

        Most hospitals are safer for deliveries BECAUSE they have the needed equipment in case of emergencies AND because they can provide c-sections when needed in emergencies. No one puts meconium aspiration or repiratory distress on there birth plans but unfortunately these things can and do happen to babies. You realize you are saying this to at least one person who has most likely seen instances of neonatal mortality and morbidity (brain damage) that have occurred after home deliveries. ANY home delivery should have emergency equipment and people trained to use them..You are all blessed to have had safe and wonderful outcomes. Perhaps you should see another side. http://hurtbyhomebirth.blogspot.com/2011_05_01_archive.html

    • Naomi says:

      Actually, according to the CDC’s most recent available data of this sort (from 2007) infant mortality rates for midwives attending out-of-hospital births are as follows:

      CNM: 2.92
      Other Midwife: 3.70

      If you’re going to group all out-of-hospital births that were not assisted by a CNM together, yes, the infant mortality rates are higher, but perhaps this is affected by the births attended out of the hospital by MDs (who are, indeed, non-nurse-midwives):

      MD: 30.61

      The national infant mortality rate for 2007 was 6.75.
      Here is my citation: United States Department of Health and Human Services (US DHHS), Centers of Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Division of Vital Statistics (DVS), Linked Birth / Infant Death Records 2007 on CDC WONDER On-line Database. Accessed at http://wonder.cdc.gov/lbd-current.html on Dec 30, 2011 5:06:48 PM

      • Amy Tuteur, MD says:

        Infant mortality is the wrong statistic. It is deaths from birth to one year of age, and as such, is a measure of pediatric care.

        Neonatal mortality (death from birth to 28 days) is considered by the WHO to be a better measure of obstetric care. Moreover, when looking at homebirth safety, you need to remove premature deliveries and correct for race, since race is a risk factor and almost all homebirths occur to white women.

        The CDC neonatal mortality rates for 2007 (white women, ages 20-45, 37+ weeks, 2500+ gm) are:

        CNM in hospital 0.34 per 1000
        CNM at home 0.82 per 1000
        non-CNM at home 2.62 per 1000

        As you can see, the death rate for CNM attended homebirths is more than double that of CNM attended hospital births. The death rate for non-CNM midwives is 7.7 times higher than comparable risk hospital birth.

        This data is available for free at the CDC Wonder website.

        There is absolutely no question that homebirth increases the risk of neonatal death. Women may want to choose it anyway, but they cannot give informed consent unless they are actually informed by their midwives of the real increased risk of neonatal death.

        • Naomi says:

          You’re right about neonatal mortality. I missed that in your original post.

          One of the mortality rates you listed were suppressed by the CDC on the grounds that there were too few deaths to meet their standards for accuracy. While, from a mathematical perspective, I do not always agree with the CDC’s limits on the numerator as an indicator of accuracy, I think it is only fair that your audience should be made aware of this. In such, far more accurate results can be achieved by looking at multiple years at once. I could look at years 2005-2007, for example, but that would necessitate me to figure it manually; so you may trust me better, here are the same criteria (including the very large and overdue babies you insist be included) for years 2003-2006:

          CNM in hospital: 0.40
          CNM out of hospital: 0.70
          Other midwife out of hospital: 1.19

          Yes, there is a difference, but not like what you’re stating.

          Patients of midwives are likely to be similar in demographic, regardless of where they are delivering. OBs and MDs are easy to come by; it’s the midwives we need to search for! You don’t “happen” to end up with a midwife. A doctor won’t send you to one. If you’re comparing midwives to midwives, it doesn’t make any sense to limit your search by demographic. Thus, neonatal mortality rates (babies all ages under 27 days is the best WONDER will let me do) for 2007 are as follows:

          CNM in hospital: 1.25
          CNM out of hospital: 1.36*
          Other midwife out of hospital: 2.67

          *This value was suppressed and thus figured manually. There were 9 deaths and 9493 births in this category.

          In addition, proportions of home births by race are not so far off. Of all births in 2007, 23% of the mothers were non-white. Of all out of hospital births in 2007, 11% of the mothers were non-white. I don’t think that is such a huge difference that it should be ignored, especially when comparing midwives to midwives. You see, almost all BIRTHS, regardless of where they take place, occur to white women. Likewise, most births, regardless of where they take place, are to full-term (or post-term, by your rules) infants. 87.2% of all births were 37 weeks gestation or older. 91.6% of out of hospital births were 37 weeks gestation or older. Are these really necessary limitations? 91.7% of hospital births in 2007 were of babies born weighing 2500 grams or more. 94.9% of out of hospital births were of infants weighing 2500 grams or more. This difference hardly calls for the limitations you have placed on your statistics. 89.3% of all births involve mothers from 20-44 years of age. 95.9% of out of hospital births involve mothers from ages 20-44. None of these seem unreasonable for comparison, especially when comparing midwives to midwives.

          • Amy Tuteur, MD says:

            Now you are simply quibbling about how much higher the homebirth death rate is than comparable risk hospital birth; you’ve essentially acknowledged that homebirth DOES have a higher neonatal death rate than hospital birth.

            It is important to keep in mind that the CDC statistics undercounts homebirth deaths because homebirth transfers are removed from the homebirth group. Therefore, the real difference between in homebirth and comparable risk hospital birth is undoubtedly more than double.

            This information is not new. The CDC has been collecting statistics since 2003. It also corroborates studies such as the Birthplace Study, which showed that even in an extremely low risk group, homebirth increases the risk of neonatal death.

            Unless and until homebirth midwives are honest about the real risk of neonatal death at homebirth, women may choose homebirth, but they are not giving informed consent.

        • Naomi says:

          Indeed, many women eschew the medical model of care because they feel there is a great lack of informed consent there. They feel that risks and side effects of drugs (sometimes even the names of drugs) and procedures (such as Cytotec, Pitocin, epidural, or cesarean section) are undisclosed. Many women are totally unaware of long-term effects of these procedures, including risks to later pregnancies. Some women feel like their care providers did not try hard enough to avoid interventions and surgery (remedying fetal distress by allowing a change in position, or by decreasing Pitocin, for example) or prevent problems (for example, leaving the membranes intact in first-stage labor to help prevent fetal infection). Many women are completely unaware that they can refuse non-medically-necessary procedures (a low-risk woman, for example, can often have a port put into her arm instead of an IV, which can increase her mobility, helping her baby move down and avoid distress due to compression of the vena cava). Informed consent is a huge object of contention in the obstetric system. I do agree that no matter what a woman chooses to do, she should have FULL informed consent, and that includes procedures and drugs in the hospital.

        • Naomi says:

          Dr. Tuteur, considering the speculation surrounding your existence and the validity of your license, I think it’s best that I bow out of this debate. My time is far better spent talking with people who have greater respect for naked truth than an agenda.

  23. Vanessa says:

    “Even MANA knows that homebirth kills babies; they just don’t want American women to know.”

    I’m sorry Amy “MD” Tuteur, but this statement is ludacris, and if you want to make statements like this you need to have info to back it up. Otherwise, you are just another doctor who is ignorant of the ACTUAL evidence and valid research that supports that homebirth is safe (as opposed to the very misleading studies that lump unplanned homebirths and births in cars and any other out-of-hospital setting in with planned homebirths.)

  24. Vanessa says:

    Regardless of whether or not you feel it’s safe, it’s a human right to give birth where a women chooses, and it’s rediculous to deny women the right to choose who they want to attend their birth because you hope it will keep women from giving birth at home.

    Some women will never want to give birth in a hospital (part of that is lack of choices in-hospital as well in Nebraska, and lack of other out-of-hospital settings to give birth such as Birth Centers.) Those women should have the right to have whomever they wish attend their birth, whether it be no attendant, an independent midwife, a CPM, or a CNM.

  25. Shanna says:

    Amy Tuteur, MD, do you have any links to the actual research studies you are referencing??

    Thank you.

  26. Halley says:

    When looking at any problem we must try to set bias aside… and for those of you who hate politics, I don’t blame you. There are a lot of things that make genuine communication difficult within our Nation’s given circumstances… but still, always strive for truth and do not fear ‘politics’ for that means ‘politicians’ will feel feared- However, there are many politicians that do not want to be feared… They are genuine in intentions and willing to listen. Seek out these individuals and get to talking… Take any situation you feel strongly about: “For if you are not part of the solution, you are part of the problem.” (Or for my science friends out there- here is a geekier version I found: “If you’re not part of the solution, you’re part of the precipitate.”) I like that version better ☺

    With that in mind, look at the given situation: If women can legally give birth anywhere, they should also be able to choose with whom they give birth. Makes sense to me. If one piece of this puzzle is missing then it is necessary to take the other piece away so women are not feeling irresponsible or unsafe when deciding where to give birth. With Nebraska law, as is, that would mean we would have to take away the right for a woman to give birth where she desires… That sounds even more dangerous to the wellbeing of babies being born at home. I have met very educated women on both sides of the spectrum. One thing in common: They want the safest birth possible no matter where they choose to give birth. Let’s focus on the common goal. Let’s make birth the safest possible for everyone, everywhere, every time. One cannot change the opinion of another person, so there is no point in arguing. Let’s start working together… maybe then we can begin to understand the positive intentions of both sides.

    With that said, may all babies be born into this world in love and respect and with the right to safe and qualified care no matter where their mother chooses to celebrate the beautiful gift of bringing life into this world.

  27. Rachel Howell -Nebraska Friends of Midwives, Chair says:

    Quickly- Ms Ernst, thank you for all the advancements you have made in midwifery. I am sure you are aware, but in case not, Nebraska’s new birth center has a room named for you. You can view it here: http://www.facebook.com/photo.php?fbid=275728282460585&set=a.275723495794397.76427.152382731461808&type=3&theater

    Generally, here is a link to a response by The American College of Certified Nurse Midwives regarding England’s new birthplace study. Links for the study are available within the response. http://www.midwife.org/England-s-Birthplace-Study-and-Implications-for-the-United-States

    Those familiar with the struggle for home birth rights know that many of the ideas suggested on this thread in opposition to home birth have been raised by the same opponent and fully addressed elsewhere online.

    And lastly, it is inaccurate to state that every woman already has the right to surround herself with whomever she chooses during a home birth.

    For more information about midwifery options in Nebraska please go to http://www.nebraskamidwives.org.

  28. Rachel Howell -Nebraska Friends of Midwives, Chair says:

    My apologies- this is link to the Ernst Suite at The Midwife’s Place. http://www.facebook.com/photo.php?fbid=275871532446260&set=a.275723495794397.76427.152382731461808&type=3&theater

  29. kitty says:

    This is not about doctors, nurses or midwives. It is about the rights of women and families in Nebraska to choose their place of birth AND for our health care system to accomodate that choice the best way we know how. Authoritative opinion and fear, which feeds control, have got us to this place. The driving force under the new health care reform is scientific evidence and that evidence according to the Cochrane Review is that women should choose their place of birth for it is important that they feel comfortable and safe. Remember we once drugged women so heavily that they had to be put in straight jackets to labor and were delivered by forceps of a drugged baby so we have not always been right about our care. Hospitals try but in looking at the redecorated room,I’m sorry to say that they missed the point. A home has a double or queen size bed not a the type shown. That bed was desigend to accomodate the care giver – not the mother and baby and family to snuggle together after the birth. The bed tells it all. This is not intended to place blame but rather to encourage folks that are trying to accomodate women to ask the mothers what they want and do it. Start by educating all nurses and doctors in the art and science of midwifery – which means being “with woman” – the sustaining presence in preganacy, labor and the postpartum mother/newborn period of adjustment TOGETHER. We are all products of our education so change must begin with the education of the care providers. How many of the nurses on this unit have ever even witnessed a home or birth center birth? Start there. Then enroll all your obsterical nurses in in one of the distance nurse-midwifery education programs. Send them to ther meetings of the American Association of Birth Centers for contiuing education. Give them every advantage to learn about the changes they appear to want to make.

  30. Roberta Leaverton says:

    I would sure like to offer my services, a BIRTH PHOTOGRAPHER located midway between Lincoln & Omaha. Home births are WELCOMED!!!

  31. Amy Tuteur, MD says:

    Ms. Ernst, please don’t cite an out of date Cochrane Review that acknowledged that at the time there was not enough data to issue a recommendation about homebirth.

    It amazes me that homebirth advocates not only ignore the large and growing body of scientific evidence that homebirth increases the risk of newborn death, but they also ignore the American Academy of Pediatrics, ostensibly those who know the most about newborn safety.

    The Guidelines for Perinatal Care published by the American Academy of Pediatrics (AAP) and American Congress of Obstericians and Gynecologists (ACOG) state that:

    “the hospital, including a birthing center within the hospital complex, or a freestanding birthing center, provides the safest setting for labor, delivery, and the postpartum period. The use of other settings is not encouraged. Further, any facility providing obstetrical care should have the services listed as essential components for a level I hospital. This includes the availability of blood and fresh-frozen plasma for transfusion; anesthesia, radiology, ultrasound, electronic fetal heart rate monitoring and laboratory services available on a 24-hour basis; resuscitation and stabilization of all inborn neonates; nursery; and other services that are not available in the home setting.”

    It’s difficult to be clearer than that. There is no hedging or equivocation. Pediatricians insist that hospital is the SAFEST SETTING and that homebirths should be discouraged. Why? Because safety demands electronic fetal heart rate monitoring, personnel and equipment for neonatal resuscitation and a nursery staffed by nurses who can monitor even well babies.

    As I said above, those who promote homebirth need to stop hiding the real risks. Women can only make informed decisions if they are informed about what the scientific evidence actually shows.

    All the existing scientific evidence, as well as state, national and international data, show that homebirth increases the risk of newborn death. Ms. Ernst, Ms. Howell and other homebirth advocates have provided no scientific evidence to support their claims, because there isn’t any.

    • Candace says:

      All my cousins survived homebirths and plenty o’ plenty of people after having horrible encounters in the hospital have gone on tohave homebirths, VBAC’s VBA2C and even having twins v.after cessarean! NEVER once an issue. EFM’s etc… all those interventions had no impact. Basically you are saying that birth is not possible without medical intervention and science. Please explain to me why US as a whole ranks 175 out of 222 countries according to
      https://www.cia.gov/library/publications/the-world-factbook/rankorder/2091rank.html when homebirths arent practiced much due to legality of the whole issue here. Infant mortality ranks high here without homebirths and yet your ideas which is the common american way is safer. Other countries that ranked with better mortality rates tend to have more midwives and homebirths than we (US) allow.

  32. kitty says:

    A thought for for Dr. Amy.

    Without rigorous standsrds for Licensure of home birth care providers in all states, it is possible that there will be preventable mrtality. However, the train has left the staion on home birth and do we not, as concerned professionals, have an obligation to implement measures to insure the quality of care for women who make this choice? In the National Birth Ceneter Study of almost 12,000 women recieving birth care in birth centers, Rooks speaks to the previous studies which had higher mortality and suggested that the reduction to a rate comparable to low risk in-hopital birth may have been the reult of extraordinary efforts to implement regulations for licensure (now 82% of states regulate) and national standards for accreditation of birth centers. If, as professionals, we want to protect mothers and babies, perhaps we need to constructively look at this need instead of condeming a woman’s choice which, as some have commented, is the result of an experience with less than optimal in-hospital care. Is it possible that Pogo was right and “we have met the enemy and it is us”? We need to listen to these parents and construct a system of care where their choices are made on the best current information, respected and accomodated as best we know how at any given time. It doesn’t help to bash midwives, physicinas, nurses OR mother and parents. Better to ask ourselves, OK, if women desire a home birth, how can we make it as safe and satisfying for them as possible – even if they plan to go it alone.A basic tenent of caring for folks is to start where they are.

  33. Shanna says:

    Amy Tuteur, MD, I get it–you say the data supports only birth facilitated in a hospital or freestanding birth center. Fine. What studies are you referring to? You keep saying all the data shows, but no citations. It is difficult, if not impossible to discuss anything with you if you continue to present vague statements about “statistical data.”

    As for the out-of-date Cochran report, do you mean the one from 2009 found here:http://summaries.cochrane.org/CD000352/home-versus-hospital-birth

    Definitely not an “out-of-date” study and while inconclusive (due to size of the research and research method utilized), it does not necessarily contradict Kitty Ernst’s statement that “women should choose their place of birth for it is important that they feel comfortable and safe.”

  34. Shanna says:

    “Better to ask ourselves, OK, if women desire a home birth, how can we make it as safe and satisfying for them as possible – even if they plan to go it alone.A basic tenent of caring for folks is to start where they are.”

    Yes, I agree. Well stated.

    Women will have home births–whether anyone agrees with it or not is irrelevant. The key is how can we ensure that the women who seek home births will have the best possible outcomes? Is is wise to restrict all care so that women are forced to have unassisted home births? Or is the wiser choice to allow trained professionals, such as CNMs, to care for their patients in a home setting?

  35. AL says:

    Do you see the photo provided by Jeanne Prentice to promote her industry? Sorry, but I like my babies pink. Hopefully, the baby in the photo was able to perk up on its own, but that’s not always the case with babes that color.

    • NebraskaDad says:

      With the greatest of respect AL, em… that is the ‘pink color’ they come out as…

      I would dare suggest that for all the mums and dads that have the baby in hospital they don’t get to look at the baby’s color till the other medical professionals have finished with all their poking, prodding and other interventions.

    • MJ says:

      Actually, that’s a mom who’s baby was allowed to not have their cord unneccesarily clamped and cut before she had the afterbirth. My daughter was that color for at least 3-5 minutes after she was born at home. She saw our family doctor that day and was and is in perfect health. That baby in the picture is great – he/she got all of the blood and oxygen from his/her placenta.

      • Alenushka says:

        Please, take an anatomy and physiology class. Once the placenta separated from the wall of the uterus, the baby is not getting blood and oxygen from the mother anymore. The only “benefit” from delayed cord clumping is increase iron storage few months from birth that has no significant change for health well fed American infants.. Again, . Again, there is not oxygen is coming to that blue baby from plthe placenta.

        • Shaye says:

          Alenushka, I find your condescending response to MJ troubling primarily because it assumes that placentas immediately detach from the uterus wall as soon as the baby is born. No matter where a birth takes place, placentas can often stay attached with a pulsing cord for some time after birth (if the cord is not tugged on).

          Truth is, no one can say what is coming to this baby if they were not actually there to investigate the state of the placenta or any cord activity. Nor do we know if this baby was immediately birthed and brought to mom’s chest seconds later or if this was taken over a minutes after birth. True coloring is extremely difficult to determine by digital photo because it depends greatly on specific camera settings, lighting, resolution, coloring of mother’s skin (i.e. whether she was tanned, etc.), and even more variables.

          If I’m not mistaken, there was actually a public call for home birth photos (for this article) on NFoM’s Facebook page just before it was published last week. Whether this picture was requested for use by the author is unknown by commenters. Furthermore, to call this CNM’s professional activity into question based on a rather fuzzy digital photo is completely inappropriate. I was unclear on whether Al and Alenushka are one in the same by IP address, but I find AL’s comment to be an unfounded petty, personal attack on Ms. Prentice. I would hope this “photo” comment thread will eventually be removed as it can easily be perceived as personal and it does not add to the discussion on unassisted birth vs. legalizing CNM-attended birth.

  36. Shaye says:

    Thank you so much for this deeper look at unassisted home birth in Nebraska. As Amy Tuteur (poster above) reminds us, ACOG prefers anyone providing obstetrical care “to have the services listed as essential components for a level I hospital”. However, that’s simply not an option for a relatively huge chunk of our state. It’s a 100+ mile drive from my surrounding area to find anything other than a basic (Level IV, if I’m not mistaken) hospital. We also don’t have obstetricians and often there’s not an anesthesiologist on the premises in the event of a necessary emergency cesarean section. We fly people out to Denver for medical help, when necessary. Therefore, a true “emergency” in a home birth (that couldn’t be handled by a CNM) would result in similar outcomes to an emergency in a rural community facility.

    Having said all this, a knowledgeable attendant in an out-of-hospital birth would be phenomenal. Smaller emergencies could be dealt with at home in a timely fashion (and back-up doctors could be notified when labor began in the event of a last minute transfer). Thankfully we *do* have home birth supportive doctors out here in the boonies of Nebraska. Some have knowingly served as back-up doctors for families who choose to find an underground midwife or for those who’ve planned to go unassisted.

    • Dierdre Earley says:

      As a registered nurse in a Nursery ICU, I agree with many of the arguments on both sides. It should not be illegal in Nebraska to pay a CNM to assist with deliveries, but it should be mandatory that they have all the necessary equipment for recussitation (such as Oxygen, intubation tubes, etc) and the necessary training to use these items. I have seen some very sad outcomes (death and neurological damage due to unplanned and unforseen problems at home deliveries (that could have been avoided).

  37. Colorado Home-Birth Busia says:

    A “Patient” is a person under medical care or treatment. If a woman goes to a hospital, that is what she is labeled and that is how she is treated, as a person under medical care. A woman at home is naturally just a Mom having her baby. Until the medical society recognizes this HUGE difference there is no talking to them. They think that having a lounge chair in the ‘labor-room’ is ‘home-like’. Totally clueless… Mom doesn’t need to be ‘monitored’ baby doesn’t need to be skewered, baby doesn’t need to be suctioned etc. etc. Will they ever ‘get-it’??? I doubt it. Shame on Nebraska! Bad laws need to get thrown out! Let’s do it!

  38. jenny heineman says:

    Look no further than Dr. Amy Tuteur’s blog, http://skepticalob.blogspot.com/ , to understand her biases. The reason she has not offered any links to the studies she cites is precisely because they are her studies– shoddy analyses of message boards and legal proceedings regarding infant deaths; deaths often spuriously related to the fact that the birth was at home.

  39. Kellie Northam says:

    “Safety for the mother and baby, Lowe said, is best found in a hospital setting.”
    Ms Lowe, this is a false statement and is not based on the CURRENT evidence. And it is certainly NOT supported by the American College of Nurse Midwives. As a member of ACNM, I am greatly offended that you allow yourself to be represented as speaking for CNMs of Nebraska. The vast majority of CNMs in Nebraska are in full support of expanding the scope of practice in Nebraska, so that our CNMs can be the midwives they have been educated to be for healthy women in ANY birth place. I strongly suggest that in the future, you refer the media to the Nebraska ACNM chapter’s president so the people of this state know the TRUTH about who Nebraska’s midwives really are.

    • Rachel Howell says:

      Thank you, Kellie, for addressing the comments made by this Nebraska CNM. It is so important for Nebraskans- citizens, senators, health care professionals- to know that ACNM and the majority of ACNM members in this state SUPPORT the option of CNM attended home birth.

  40. Jessica says:

    Oh Dr. Amy!

    You are right! Everyone should be informed of all risks involved with birth when they are speaking with their birth attendants. I have had one hospital and two homebirths with Certified Professional Midwives (the villains you mentioned above.) My OB/GYN did not inform me of any of the risks of the many things that could have or did happen to me in the hospital. Yet for both of my homebirths, the first interview with the midwives was all about them laying out the risks of homebirth, what would happen in various emergency situations, and what I could expect if something were to go wrong. I felt much more informed about the risks of homebirth and using a midwife far from a hospital than I ever did about hospital procedures.

    And one more point since I don’t want to spend any more time on this: you state “All the existing scientific evidence, as well as state, national and international data, show that homebirth increases the risk of newborn death. Ms. Ernst, Ms. Howell and other homebirth advocates have provided no scientific evidence to support their claims, because there isn’t any.”

    Amazingly enough, we have several studies which *do* support our claims. Most recently, http://www.bmj.com/content/343/bmj.d7400.short?rss=1&utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+bmj%2Frecent+%28
    which summarizes their findings as follows:

    What is already known on this topic

    Healthy women who plan to give birth at home or in a midwifery unit are more likely to have a vaginal birth with less intervention compared with women who plan to give birth in an obstetric unit
    There is a lack of good quality evidence comparing the risk of rare but serious adverse perinatal outcomes in these settings

    What this study adds

    For healthy women with low risk pregnancies, the incidence of adverse perinatal outcomes is low in all birth settings
    For healthy multiparous women with a low risk pregnancy, there are no differences in adverse perinatal outcomes between planned births at home or in a midwifery unit compared with planned births in an obstetric unit
    For healthy nulliparous women with a low risk pregnancy, the risk of an adverse perinatal outcome seems to be higher for planned births at home, and the intrapartum transfer rate is high in all settings other than an obstetric unit

  41. Amy Tuteur, MD says:

    “Without rigorous standsrds for Licensure of home birth care providers in all states, it is possible that there will be preventable mrtality.”

    Ms. Ernst, you ought to know that there is copious data on both licensed and unlicensed providers and ALL of it shows that homebirth increases the risk of newborn death.

    1. Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004, (MH Malloy, Journal of Perinatology (2010) 30, 622–627)) is the most comprehensive study to date on CNM attended homebirth. It showed:

    “The neonatal mortality rate per 1000 live births for each of these categories was, respectively, 0.5 [CNM in hospital], … 1.0 (deaths=[CNM at homebirth], 1.8 [non-CNM at homebirth] …

    Conclusion: Deliveries at home attended by CNMs and ‘other midwives’ were associated with higher risks for mortality than deliveries in-hospital by CNMs”

    2. As far as licensing non-CNM midwives, it appears to make no difference. The death rates are appalling for CPMs and other lay midwives regardless of whether or not they are licensed by the state.

    In Colorado, where all homebirth midwives have the CPM or equivalent credential and are licensed, the death rate for licensed midwife attended homebirth is high and has risen every year since licensing was instituted. In 2009, Nine (9) babies died for a homebirth death rate of 11.3/1000! That is nearly DOUBLE the perinatal death rate of 6.3/1000 for the entire state (including all pregnancy complications and premature births).

    The data is conveniently broken down by type of death and place of death. For example, there were three intrapartum deaths for an intrapartum death rate of 3.8/1000, more than TEN TIMES HIGHER than the intrapartum death rate commonly experienced in hospitals. There were 4 neonatal deaths for a neonatal death rate of 5/1000. That’s TEN TIMES HIGHER than the national neonatal mortality rate for low risk hospital birth with a CNM.

    3. In Oregon, where licensing is optional, there have been at least 19 deaths reported to the Board of Direct Entry Midwifery in the past 10 years for a mortality rate

    To put that in perspective, consider that there are approximately 1000 homebirths per year in Oregon and that the neonatal death rate for low risk women in a hospital setting is 4/10,000 (0.4/1000). That means that you would expect approximately 4 homebirth deaths per decade. Instead there were at least 19 deaths, for a rate more than 4X higher (375%) than expected.

    No less than 16 midwives have presided over at least one death. Interestingly, only 2 were unlicensed midwives.

    4. A recently paper published on homebirth in Missouri, Birth outcomes of planned home births in Missouri: a population-based study (Chang and Macones, American Journal of Perinatology, August 2011) showed:

    “Rates of neonatal death were 1.4/1000 among planned homebirths attended by non-CNMs, 0 among planned homebirths attended by physicians/CNMs and 0.6/1000 among hospital/birth center births attended by physicians CNMs.”

    Thus far, Ms. Ernst, you’ve presented not a shred of scientific evidence supporting your claim that homebirth is safe. That’s because it isn’t safe. ALL the existing scientific evidence, as well as state, national and international statistics shows that homebirth increases the risk of newborn death.

    It is unethical for homebirth midwives to continue to hide or ignore the large and growing body of evidence and fail to inform their clients of this evidence.

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