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Home birth supporters praise new Indiana law

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EMILY CAMPION

Journal & Courier

LAFAYETTE, Ind. (AP) - Sitting at a table in a downtown Lafayette coffee shop, four mothers, all experienced in home births, talked about what they consider a long-overdue law - House Bill 1135 - concerning midwife-assisted home births.

“We’ve been trying to do this for 20 years. Some people gave up hope that this would happen,” Jennifer Beaver of West Lafayette said. She had a child at home after four hospital births that left her feeling disappointed.

For Hoosier mothers-to-be, options for home births have been limited by a law that made it illegal for some professional midwives to assist with home births.

With the signing of HB 1135 into law on May 11, that changed. The law, once it takes effect and new regulations are written, will allow certified professional midwives, or CPMs, to conduct home births, provided they meet yet-to-be designated license requirements.

But why is this bill a benchmark in Hoosier midwifery history?

According to the women at the table, for two reasons. First, it sets a standard of care. Second, it opens the possibility of home births to an entire class of midwives who have been locked out of the market in Indiana.

Until passage of the law, the only class that could legally perform home births was certified nurse midwives, or CNMs. Many work exclusively with hospitals or obstetric practices, the Journal & Courier reported.

Certified professional midwives, on the other hand, assist at home births at their own risk. It’s a Class D felony for a CPM to conduct a home birth under the old law, according to Mary Helen Ayres, president of Indiana Midwives Association.

Dawn Ogas of West Lafayette said the new law just makes sense.

“I just think this gives ... everybody a choice,” she said. Ogas had two of her children at home and two in hospitals.

Many women who preferred to have home births have gone underground to find a midwife willing to assist.

“Because of the circles and the friends, we have found the professionals to allow us to have the home births, but it’d be great to be able to come to town and look in the telephone book now,” she said.

Certified nurse midwives earn bachelor’s degrees in nursing plus a master’s-level degree in nurse midwifery. They then must pass an exam through the American Midwifery Certification Board.

Certified professional midwives are required to fulfill two to four years of academic work, followed by clinicals and assessments.

The law just signed, which will go into effect in July, will add CDEM - Certified Direct-Entry Midwife - to a CPN’s credentials upon meeting the additional state requirements.

Sharon Smith began practicing as a certified nurse midwife more than three years ago. She chose to practice the midwife model in a hospital setting - IU Health Arnett - through which she has liability and malpractice insurance.

It would be difficult, she said, to survive as an independent certified nursing midwife without the backing of a hospital or private practitioner because of those expenses.

“It’s also very difficult then to get any type of established collaborative relationship with an OB,” Smith said. “If I just wanted to be on my own and do home births, if problems arose, then we would just have to show up at the hospital.”

And complications do happen, Smith said.

“There’s been times I’ve been very grateful and very appreciative I had the additional level of care readily available.”

Complications didn’t happen for Elissa Dinell, but the fear of them deterred her from having her second child at home. She gave birth to her first child in a hospital with an obstetrician, but the negative and painful experience led her to midwifery.

Dinell said she thought about home birth: “I started discussing it with my husband, and we just ... preferred being in the hospital just in case something did go wrong.”

While the health of mom and baby is the most important thing to both midwives and obstetricians, it can be frustrating for on-call physicians to have to deliver for a home birth gone wrong.

Dr. Deb Madura, OB-GYN at IU Health Arnett, said complications from home births don’t happen often but can be bad.

“We see the worst of the worst,” Madura said. “We have a skewed perspective.”

“I know people who have had home births and had a wonderful experience. It sounds really nice, and 90 percent of the time they go well,” she said. But, Madura said, “What’s your backup plan?”

The Committee on Obstetric Practice of the American College of Obstetricians and Gynecologists released a statement in February in the wake of a new wave of support for home births.

The statement read, “Although the Committee on Obstetric Practice believes that hospitals and birthing centers are the safest setting for birth, it respects the right of a woman to make a medically informed decision about delivery.”

In April, the American Academy of Pediatrics released a similar statement, echoing the concerns of home births and newborn safety.

Reaction to this bill seems to be anything but critical.

“It will also help mothers who are seeking, or families who are seeking, a caregiver to really have that information so they make sure that they’re going to get a midwife that really does know her stuff,” Beaver said.

Ogas nodded in agreement.

“And this just allows for new midwives to say, ‘Wow, I could actually make a living and do what I want to do in the state of Indiana’,” Ogas said. “We got to the point where there’s nobody new coming in - because what’s the point? You can’t do it. Why even come here?”

“I had considered it,” said Heather Yurkus of Lafayette, “and looking at the mess and the legal matters, I just backed off.”

Yurkus had four of her children at home and her final child in the hospital because of a foreseeable complication that gave her days to find an OB.

“What I’ve seen in my circles is a lot more enthusiasm,” Beaver said of the bill.

Ayres, who lives in Bloomington, hears a lot of support for it.

“We believe strongly in our responsibility to be accountable for people in our state,” she said. It could be insulting to those who have been practicing for a long time, she said, but it’s worth it.

Ayres spent a recent day combing through the bill with 15 other midwives. Though the creation of a midwifery committee is months away, it’s at least a first step, she said.

“We appreciate stringent educational requirements for midwives. That’s fine, that’s good. That’s in the interest of families who hire us,” Ayres said.

“This state’s going to turn out some deeply experienced people. By the time midwives are getting their certificate, they will be more than ready to be on their own as an independent practitioner.”

 

Posted 6/13/2013