Midwives seek state sanction

N.C. among few states banning direct-entry home births

by Jordan Schrader, JSCHRADE@CITIZEN-TIMES.COM

published February 24, 2008 12:15 am

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RALEIGH — For two Fairview women, the births of their first children couldn’t have gone more differently.

Jenn McCormack gave birth to Olivia surrounded by her husband, a doctor, a nurse, a doula and several resident doctors. “It was bright lights and a really just cold environment,” she said. “I don’t know. It just didn’t feel right.”

To bring Savannah into the world, Sonya Stone chose her dining room.

The table and chairs were moved out, and a 300-gallon agricultural tub was moved in. She and her husband, Todd, grabbed their daughter as she went into the water, under the eye of two trusted midwives.

Stone and McCormack are now pushing the General Assembly to make home births more widely available to women in North Carolina, one of 10 states in addition to the District of Columbia where the kind of delivery Stone chose is illegal.

They and their allies want the state to license direct-entry midwives, the kind trained for home birth who work without a nursing degree and without physician oversight.

That change, being weighed by a House study commission, faces opposition from North Carolina’s medical establishment.

“A step toward home deliveries, we feel, would be counterproductive — a step into the past — and prevent us from lowering our infant mortality rate,” Dr. Frank Harrison, of Charlotte, state chair for the American College of Obstetricians and Gynecologists, told the commission last week.

Births should be monitored at a hospital or birthing center, the group says, because complications can arise with little or no warning.

About 15 minutes after a recent delivery Harrison performed, the woman began to hemorrhage. She wouldn’t have survived if she had been at home, Harrison said.

Home help hard to find

Home births are legal in North Carolina for families who want to perform the delivery on their own or with the aid of medical professionals like physicians or nurse midwives, who have a degree in nursing and report to a physician.

But direct-entry midwives, even those certified by the North American Registry of Midwives, may not legally attend births on their own.

Asheville midwife Nancy Koerber, co-owner of New Dawn Midwifery, gets around the prohibition by attending births accompanied by a nurse midwife. She said the state’s other certified midwives, perhaps a dozen in all, mostly work underground.

The N.C. Medical Board is not seeking prosecution for midwives working without a license, said Thomas Mansfield, the board’s liaison to the legislature.

But advocates of licensing direct-entry midwives say the ban leaves mothers unsafe. Illegal attendants have no access to lab testing. If complications force them to drop a mother off at the hospital, they may be afraid to go in, depriving doctors of needed information.

Stone and Koerber said the main alternative, nurse midwives, number too few to meet the demand.

There were 190 nurse midwives in North Carolina in 2005, according to the American College of Nurse-Midwives. But Koerber said New Dawn is one of just three practices offering home births. Others are in Burnsville and the Triangle.

“There’s only so many home births that my practice can handle,” said Koerber, whose New Dawn midwives attend 40-50 a year.

Koerber said she knows of just one doctor in North Carolina who performs home births — he’s in Asheville — and nurse midwives have a hard time finding doctors to even supervise them.

Physicians balk mainly out of safety concerns, she said.

They also have their liability to consider.

Insurance companies don’t offer malpractice insurance for doctors to perform home births, Koerber said.

Change sought

Stone said births shouldn’t be seen as a medical procedure. Hospitals put a premium on revenue and efficiency, she said, charging high costs and making Caesarean sections routine.

“Hospitals are for sick people, and they do a really good job treating sick people, but birth is a normal process,” Stone told lawmakers.

Lobbied by advocates like Stone, Rep. Charles Thomas, R-Buncombe, submitted language to legislative bill drafters last year but never turned it into a bill. He said the supporters didn’t meet with doctors and trial lawyers seeking common ground, as he had encouraged.

So Rep. Ty Harrell, D-Wake, won legislative leaders’ agreement to form a commission to study the issue. The panel includes medical professionals as well as Thomas, Harrell and other lawmakers, and is co-chaired by Rep. Bobby England, a doctor and Democrat from Rutherford County.

After the panel’s first meeting, Thomas was skeptical of the proposal he called “an end run around medical school” but said a compromise might be reached if concerns about safety and liability are met.

Licensing would likely have some undetermined clerical cost to the state, Harrison said, even if certification was done by the North American Registry of Midwives as in other states.

But Thomas said the cost might be offset by lower health care costs if midwives deliver the less expensive care they promise.

Contact Jordan Schrader via e-mail at jschrade@gannett.com