N.C. panel to consider easing rules for home births

By Catherine Kozak

The Virginian-Pilot

© January 19, 2008

Kill Devil Hills

Plenty of old-timers on the Outer Banks were born safely at home, in the days when that was the only way. But now, women who want that option are thwarted by the lack of trained midwives serving the barrier islands.

With high rates of Caesarian sections and dissatisfaction with maternity care that can be expensive and sometimes impersonal, there is significant interest in giving women a choice on the Outer Banks. Women here have to go underground for a home birth or drive elsewhere to have a midwife-assisted delivery.

A state panel this year will be considering whether to allow certified professional midwives to attend births in the home. Certified nurse midwives can attend home births in North Carolina, but they must have a doctor backing them up, and there are none based on Outer Banks.

“The Business of Being Born,” a newly released documentary about birth in America produced by former talk show host Ricki Lake, was previewed at the Outer Banks Brewing Station last week, attracting about 75 people .

The film, – compared in importance by one reviewer to Al Gore’s “An Inconvenient Truth,” about the problem of global warming – highlights the difference between a home birth with a trained midwife, and a hospital birth.

Proponents say home births allow a woman to labor and deliver naturally with dignity and support. Hospital births, they said , tend to be more impersonal with interventions that include drugs and surgery.

“Women should have a choice,” said Amanda Finchem, an organizer of the event. “They should have access to local midwifery care.”

North Carolina is one of 10 states where a certified professional midwife, who typically is trained through an apprenticeship and does not need a nursing degree, cannot practice legally. They have been legal in Virginia for the past two years.

“I feel that this is a serious mistake, given that our state consistently ranks poorly in terms of neonatal and infant mortality statistics,” Henry Dorn, a High Point OB-GYN and founder of North Carolina Physicians for Midwives, said in an October letter to colleagues. “Maternal health and access to maternity care are clearly significant contributors to this.”

In 2006, North Carolina’s C-section rate was 30.3 percent, according to the N.C. State Center for Health Statistics. The national rate was 31.1 percent, according to the Centers for Disease Control and Prevention.

For about 10 years, the North Carolina Friends of Midwives has been lobbying the General Assembly to change the law, said Victoria Brown, founder and director of the group.

Now, a new study committee on midwives has been established by the North Carolina House of Representatives.

The Select Committee on Licensing Midwives will hold its first meeting on Feb. 13, said Karen Cochrane-Brown, the committee’s co-counsel.

The committee, which has been asked to study the need to license midwives to provide prenatal and postpartum care and attend labor and delivery, is expected to deliver a report by year’s end.

Caron Jones, a certified nurse-midwife from Pittsboro, was selected to serve on the committee. Jones is the former director of the Outer Banks’ only birthing center, which closed in 2003.

Today, there is no full-time midwife who serves the Outer Banks, said Ashley Davis, a certified nurse midwife at Northeastern OB-GYN in Elizabeth City. Davis also has a part-time office at Regional Medical Center in Kitty Hawk.

Davis can do everything an OB-GYN does, except perform surgery or attend to high-risk patients. She delivers babies at Albemarle Hospital, but technically she is not limited to a hospital.

“A home birth is legal in North Carolina, but you run into a problem in North Carolina because I have to have a physician back me up,” she said. “There’s not that many physicians who are willing to do that, I think because of the legal ramifications and also because of insurance.”

Although she has a very good working relationship with local physicians, Davis said, doctors and pregnant women need to learn more about the benefits of using a midwife .

“There’s a lot of women who want a midwife at their birth because they want that support,” she said.

Studies show that home births with a midwife cost about one-third of a hospital birth, and both the mother and the baby have fewer complications.

Brown said there are only three midwives in North Carolina who can do home births with the required doctor backup. But people in the state have home births anyway because they do not want the hospital experience, or their area lacks an OB-GYN or hospital.

“They have a right to have qualified care when they choose a home birth,” Brown said. “It’s also a reproductive right for a woman to be able to choose where she has her baby and whom she wants to attend it.”

Catherine Kozak, (252) 441-1711, cate.kozak@pilotonline.com

Article found at http://hamptonroads.com/2008/01/nc-panel-consider-easing-rules-home-births