Should Midwifery be Legalized in Utah?

When I was about five months pregnant I had to go to the hospital for some light bleeding. I spent about six hours waiting for doctor calls and test results. After hours of confusion and frustration I finally called a midwife. She explained what was going on and demanded that the doctor tell me my test results. The doctor wanted to keep me there over night but she thought that was unnecessary. Bleeding can occur simply from exercising or any other type of irritation to the cervix. I went home that day and decided that I would find out about midwives and homebirth.

After days of research and prayer my husband and I decided to go to a midwife. In a normal healthy pregnancy, a home birth assisted by a certified midwife is far superior to a physician assisted hospital birth because it is safer and more convenient. We were able to have our sweet baby girl in the comfort of our own home, assisted by a midwife. However, shortly after her birth a year ago, we discovered that a St. George midwife had been arrested for administering life-saving drugs to her patient. Midwifery became illegal in Utah. Citizens are not refused their right to deliver their babies how, where, and with whom they chose but midwives are only allowed to "catch" the baby. Prenatal exams and any other intervention is strictly prohibited.

Because midwifery was made illegal in Utah, a group of midwives and home birth supporters created a bill that, if passed, will legally define direct-entry (non-nurse) midwifery and expressly legalize it. Midwives will also be allowed to legally obtain and administer some life-saving medicines if they are qualified and choose to certify with the state to do so.

The direct-entry midwife act should be passed in Utah because midwife assisted homebirth is safer and more convenient than hospital birth. In a midwife assisted homebirth, exclusive attention and support is given to the birthing family. Also, mothers who birth at home are more comfortable. There are no beeping machines or nurses poking and prodding you just when you are trying to sleep. Mothers are in their own beds, surrounded by the people they love.

Home birthing mothers are in control of the labor and birth experience. They push when they want to push. They call the shots when it comes to being checked for dilation or birthing position. A mother knows her own body better than any doctor. At the hospital, women lay flat on their backs with their legs in stirrups to make the birth more convenient for the doctor.

Midwife assisted home birth is safer for many reasons. In one study, Lewis Mehl compared a group of 1046 planned home births with 1046 hospital births (Mehl). The mothers involved were matched for every variable know at the time to influence maternal and newborn outcomes. Shoulder dystocia, Fetal distress, babies requiring resuscitation, birth injuries to newborns, infection rates in newborns, meconium aspiration, pneumonia in infants, respiratory distress in newborns, apgar scores measuring the infant, cesarean rate, and forceps rate are all considerably higher in the hospital.

The study done by Lewis Mehl also compared the outcomes of the mothers. He discovered that the rates for maternal high blood pressure were five times higher in the hospital. He also revealed the fact that maternal postpartum hemorrhage was three times higher in the hospital. The episiotomy rate was an unbelievable nine times higher in the hospital and the rate of third degree tears was over three times higher in the hospital than at a home birth (Mehl).

Many people are opposed to home birth. Although it is growing in popularity all over the world, many mothers-to-be in the United States don't know much about it. They have many concerns that are valid and need to be addressed in order for them to feel comfortable birthing their babies at home with a certified midwife. Some of the main arguments and concerns about home birth are: the fact that it doesn't provide the emergency equipment that hospitals have available; since midwives are not required to have any kind of certification, parents worry about their midwife being qualified and able; and the fact that there is no epidural anesthesia available to mothers who birth at home.

There are thousands of different midwives all over the world. The responsibility of choosing which one is most suitable falls directly upon the birth mother and her partner. It is her responsibility to ask for degrees, certifications, as well as information on the number of deliveries a midwife has experienced. However, the midwife certification act will clear away this complication. An expectant family would be wise to choose a few midwives and then compare them to one another. This gives the expectant parents an opportunity to closely examine the midwife's credentials and history. The history and credentials of a physician are not so readily available.

Most people feel that it is safer to have all of the technology and expertise right there with them in case something goes wrong. But it actually isn't. One clear message of studies comparing home and hospital birth is that fewer complications occur at home. Many complications result from interference with the birth process (Tyson). Often, one intervention causes a problem which results in another intervention, and so on, causing a chain reaction of complications in birth. For example, since it is difficult for a laboring mother to move around during her labor (she usually has both an IV line and fetal monitor attached, effectively eliminating all movement), she has trouble coping with the pain. Eventually she needs an epidural to help her cope. The epidural eases the pain, but causes her labor to slow or stop (a very common occurrence with epidurals). She is then given pitocin to stimulate her labor, which causes abnormally long and hard contractions which reduce the blood supply to the baby. The baby goes into distress, and is delivered shortly thereafter by cesarean section (Duran). Had this mother been at home, the string of complications would never have begun.

All drugs used in childbirth are dangerous. Even in small or normal doses, every now and then someone receives an epidural that is more sensitive than the average person, and this can have disastrous results. There are countless side effects to the epidural. An infection can even develop at the site of the injection. On the other end of the spectrum, the more horrifying side effects of an epidural include permanent disability or paralysis as well as death.

Every female member of a family beginning with Eve, right down to our own great-grandmothers had a natural unmedicated birth. Medication for childbirth was unavailable at that time and only in the last few generations was unnatural or medicated childbirth even a possibility. According to Duran, the majority of births today, worldwide, are unmedicated. Birth is not without pain. Birth is never without risk, this may be even truer lately as the U.S. currently ranks 24th in worldwide infant mortality (Duran). Could it be possible that the pain is not all bad and may have some kind of a purpose? Pain can be minimized, rearranged, changed or postponed but it is never truly gone. The saddest thing about obstetrical anesthesia may be that if it does work, it robs the mother of feeling the birth of her baby. A birthing mother's body gives her cues while she is laboring. Actions are naturally taken as a result of this. Mothers who have numbed their bodies are unable to feel these cues and so action that may facilitate an easier or quicker labor is not taken.

Epidurals can cause backache, abnormal uterine contractions, neurological disabilities, and headaches, among other things. They don't always work and they are not safe for the baby. Drugs used in epidurals can reach levels at least as high as those in the mother, and because of the baby's immature liver, these drugs take a long time- sometimes days- to be cleared from the baby's body. Although findings are not consistent, possible problems, such as rapid breathing in the first few hours and vulnerability to low blood sugar suggest that these drugs have measurable effects on the newborn baby.

All of these risks are present in every administration of epidural. Epidurals are not available at home births. This is one of the best reasons to deliver a baby at home. Mothers who are educated on the possible risks of epidural anesthesia are unlikely to request they be given one. Home birth does not even facilitate this request. There are many methods of natural pain relief such as relaxation and counter pressure. These methods are almost never offered or explained to birthing mothers in the hospital.

Women who have normal healthy pregnancies are safer and more comfortable giving birth to their babies at home assisted by a certified midwife. The hospital can be useful in circumstances involving high risk pregnancy or emergency situations. Midwives should be allowed to administer life saving medicines to their clients without any fear of being arrested. This is a problem for midwives, expectant parents, anyone who ever considers having children, or those interested in preserving lives and preventing injuries. Based upon the evidence I have given, the Direct-entry Midwife Act should be passed.

References:

Mehl, L.E. (1977). Outcomes of elective home births: a series of 1,146 cases. Journal of Reproduction, 19, 281-290.

Duran, A.M. (1992). The safety of home birth: the Farm study. American Journal of Public Health, 82(3), 450-453

Tyson, H. (1991). Outcomes of 1001 midwife-attended home births in Toronto, 1983-1988. Birth, 18(1), 14-19.