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As we work to update South Dakota laws to reflect what is working in other states we often encounter these questions.
Is Birth Outside a Hospital Safe?
There have been many studies that have analyzed the safety of home birth. The overwhelming majority of these studies find that when comparing women of similar risks, outcomes for mothers and babies who planned out of hospital births had similar mortality outcomes, but far fewer interventions and birth injuries than their peers who planned hospital deliveries. The Division of Midwifery in the Faculty of Medicine at the Universityof British Columbia, in collaboration with the AmericanCollegeof Nurse-Midwives and the Midwives Alliance of North America, published an Annotated Guide to Home Birth Research. This bibliography, which will be updated periodically, provides citations and critical appraisal of original studies on home birth and ranks the studies in terms of their quality.
What are the Financial Benefits of Out of Hospital Maternity Care?
The cost of giving birth in a hospital ranges considerably depending on the type of delivery and the interventions utilized. According to Childbirth Connections, the range in facility fees (not including newborn fees, anesthesia fees, or care provider fees) is $9,617 – $21,495. These averages were calculated for 2009. In that same year the average facility fee for birth centers was $1,872. Home birth has no facility fees. Midwives surveyed in the South Dakota area generally charge $2,500 – $4,500 for a home birth which includes pre-natal and post-partum care.
Some states are taking advantage of the huge cost savings realized when they provide families on Medicaid access to licensed midwives providing home birth services. The state of Washingtoncommissioned a cost analysis of their midwife program and found they saved $10 for every $1 they spent on the program. A link to the report and a letter summarizing the success of their program are linked below.
Letter from Jeffery Thompson, MD, MPH, Chief Medical Officer from the Washington State Department of Social and Health Services regarding cost savings utilized with licensed midwives.
What are the Trends in Out of Hospital Birth?
More and more families are choosing to deliver their children outside of a hospital. The National Center for Health Statistics (NCHS) part of the Center for Disease Control (CDC) published a report showing a 29% increase in U.S. home births between 2004 and 2009. In that same time period South Dakota showed a 92% increase in out of hospital births.
What is the difference between different kinds of midwives?
Certified Nurse Midwives (CNMs) have completed nursing school as well as additional study in nurse-midwifery. Their credential is granted by the American Midwifery Certification Board(ACMB) and they are licensed in all 50 states. CNMs usually practice in a hospital setting where South Dakota requires them to have a written collaborative agreement with a physician. Because of a change in our law in 2008, CNMs assisting with out of hospital births are not required to have this agreement. While we have several CNMs attending home births in the state, there are still many families who have no access to midwives in any setting.
Certified Professional Midwives (CPMs) are the only US health care providers with required training in out of hospital maternity care and enter directly into didactic and clinical training in midwifery. They must complete the requirements established by The North American Registry of Midwives before they are eligible to take the 8 hour competency-based exam. The CPM credential was first issued in the early 1990’s and with over 2000 CPMs certified, has become one of the fastest growing health care professions in the nation. CPMs are licensed or legally recognized in 27 states. South Dakota is one of the states working to update our laws regarding CPMs. Under our current laws, distinguished midwives such as Ina May Gaskin, recipient of the 2011 Right Livelihood Award, and Robin Lim, the 2011 CNN Hero of the Year, can not legally assist our families.
Both NARM and the ACMB are accredited by the National Commission for Certifying Agencies. Midwives, regardless of the type of credential they might have, strive to practice according to the Midwives Model of Care.
What is the Midwives Model of Care?
The Midwives Model of Care sees pregnancy and birth as normal parts of the life cycle. Midwives who adhere to this model will:
- monitor the physical, psychological, and social well-being of the mother throughout the childbearing year.
- provide mothers with individualized education, counseling, prenatal care, continuous hands-on assistance during labor and delivery, as well as postpartum support.
- minimize technological interventions.
- identify and refer women who require obstetric care.
There is an excellent brochure that Citizens for Midwifery has published on the Midwives Model of Care. You can download it for free here.