The American Congress of Obstetricians and Gynecologists states that each woman has the right to make a medically informed decision about what type of delivery she wants and where she wants it. If she chooses to have out-of-hospital births, she should have access to appropriately licensed midwives who have access to hospitals.
The past 15 years, I met many new mothers to healthy babies. The majority had hospital births, where some welcomed pain medication, but a handful lamented feeling powerless and pressured into medical intervention such as getting Pitocin, an epidural, and sometimes a Caesarean section.
On the other hand, mothers who delivered out of hospitals, with midwives, could not relate to the fear, or powerlessness; their midwives coached them calmly through natural childbirth. The fathers I met, who experienced home or birth center births, especially after comparing to a hospital experience, are the biggest midwife advocates.
My anecdotal evidence is shared with a healthy niche of Charlotte mothers and families. From 2009 to 2015, across the border in South Carolina, the Carolina Community Maternity Center (CCMC) served families from Charlotte, who desired natural birth in a non-hospital setting. This facility was run by Certified Professional Midwives (CPMs) licensed in South Carolina, also known as direct-entry midwives, not trained as nurses or doctors, instead trained via the National Association of Certified Professional Midwives. Since the closing of that birth center, Baby+Co. has opened in Charlotte, adjacent to the uptown hospital centers, to serve families seeking natural birth. Certified Nurse Midwives (CNMs) deliver the babies, but they cannot operate independently from OBGYNs in North Carolina, as opposed to the birth center in South Carolina.
According to the CDC, in 2014 in the US, more than 30 percent of births were by Caesarean section although the WHO recommends that rate be ideally between 10-15 percent.
A midwife who worked at the CCMC gladly shared with me their data: in the six years of its operation, approximately 650 babies were born there. Between 8-11 percent of the mothers were transferred to hospitals during labor (right on target with Midwives Alliance of North America guidelines); of those transferred, one third ended up having a Caesarean section – less than 3 percent of the total births. There was one still-birth, in transport to the hospital, and one infant death of natural causes. There were two civil suits filed by one attorney and settled by the insurance company. Despite these encouraging numbers, the facility closed, because S.C. Department of Health & Environmental Control changed regulations for affiliated doctors, such that by the last year of CCMC’s operation, they had conflicts of interest with their primary practices.
Mostly, CCMC benefited from numerous repeat and referred-by-word-of-mouth families, who still actively seek out the midwives today in and around Charlotte.
In addition to low Caesarean section rates, birth center midwives take out the fear of pain and instead promote the joy of the event, help the mothers focus on the innate capacity of the woman’s and baby’s body to power the birth. This offers health and financial benefits: birth center births cost a fraction of a birth in a hospital. The CCMC charged $4,000 for prenatal care, labor and delivery, and post-natal check up. Hospital births in North Carolina are 1.5 to four times more expensive.
Nationwide, out-of-hospital births are at 1.5 percent, of which almost two thirds are home births — that rate is increasing and in 2014, home births were nationally at the highest rate since 1989. According to Mecklenburg County Health Department data, Charlotte-Mecklenburg follows the national trends of increasing out-of-hospital births since 2011.
Despite these shifts and growing numbers in favor of birth choice including out-of-hospital births with the assistance of midwives, it is illegal for a midwife to attend the birth in Charlotte (although it is legal to have a home birth), because CPMs are not licensed in North Carolina – they are licensed in 28 other states. CPMs attending a home birth in North Carolina can be charged with a misdemeanor for practicing without a license.
CPMs in Charlotte and North Carolina are organizing to end the underground status of their profession. They created the Friends of Midwives to lobby with Senate Bills S542 & S543 for legislature to enact their licensing.
As one Charlotte midwife told me, North Carolina CPMs simply want to become official and legal partners within the reproductive healthcare system, their focus being low risk natural childbirth at home or in Free-Standing Birth Centers with access to hospitals and doctors when needed in the typical 10 percent of transfer cases.
Photo: Courtesy of Baby+Co./Charlotte Observer