I no longer blindly support homebirth midwives. I have to get that out there. I used to, but now I don’t. I used to put them up on a pedestal and revere them — doing WOMENS WORK, helping other women — but I know now that is not entirely true. Because I’ve seen some midwives who have harmed women.
I saw it years ago, when a homebirth midwife, a CPM who is still licensed and had two apprentices with her, left a pregnant woman whose labor had arrested. In retrospect, the midwife should have transferred her to the hospital for hydration and probably some pitocin. But instead she abandoned her. The mom ended up going to the hospital by ambulance.
My own first homebirth with a CPM did not go very smoothly. First of all, I wasn’t a great candidate for a homebirth, having had absolutely no prenatal care and being morbidly obese. I was probably anemic as well. Still, a CPM took me on and then after My Masterpiece was born I had a retained placenta and a postpartum hemorrhage. I also went to the hospital by ambulance.
Cousin It’s homebirth was excellent — but I had a lot of medical intervention during my pregnancy. I saw a homebirth-friendly obstetrician. Because I’d had weight loss surgery between My Masterpiece and Cousin It, she kept an eye on Cousin It’s growth via several ultrasounds. I also had my labs drawn regularly, and I received iron infusions when my ferritin and hematocrit were dangerously low. (My awesome hematologist was supportive of homebirth.)
I reminded my midwife about my history of having a retained placenta and postpartum hemorrhage and I asked her to be very conservative about blood loss — and liberal with anti-hemorrhagic medications. With her during the birth was another CPM and a nurse. I was in good hands. It was a beautiful homebirth.
Meanwhile, I hear and read a lot of homebirth horror stories. I saw some scary stuff (to me) during my brief tenure as a CPM apprentice — one of the reasons I stopped was because it felt like too much pressure, having two lives in my hands. I’m not sure I would have ever felt qualified.
That brings me to a second issue: the lack of standards among CPMs. Because they are regulated by state, what’s allowed in one state isn’t allowed in another. What education and experience is necessary in one state isn’t necessary in another.
A great example is Oregon — a midwife in Oregon need not even complete an education in midwifery! And in Texas, midwives can attend breeches, multiples and VBACs; South Carolina midwives cannot attend any of those. What I’m saying is, there probably ARE some good, experienced, well-qualified CPM out there — but you can’t tell that just by the initials behind their names.
And I do not see women encouraged to ask a lot of questions of their homebirth providers, specifically about their experience (or lack of), their education, the circumstances in which they transfer, the back-up plans, or how much experience their apprentices have. It’s almost like questioning a midwife is some sort of red-light that the woman doesn’t TRUST BIRTH implicitly. And not just TRUSTING BIRTH is bad, according to many midwives and homebirthers.
I mean, I trust my driving but that doesn’t mean I don’t wear a seatbelt. I trust Whole Foods Market but that doesn’t mean I don’t cook a chicken thoroughly. Trusting birth blindly is not a point of view with which I agree.
Right now I stand for more strict standards across the board for CPMs. More education and experience requirements, and apprenticeships with multiple midwives, if possible. A national standard so that the term CPM can actually mean something. And more transparency! MANA — the Midwives Alliance of North America — won’t even publicly release their death rates. That is shady.
Would I discourage my daughters — or daughters-in-law — from having a homebirth? No. But I would insist that they understand their midwives limits and experience and education. I do not want them to just TRUST BIRTH.