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Entries in Homebirth (3)

Monday
Sep192011

Newborn's Death Revives Debate over Mandatory Midwife Licensing

Photodisc/Thinkstock(EUGENE, Ore.) -- Oregon's thriving midwife community has long operated outside the bounds of state regulation, but a recent increase in safety reports combined with the highly publicized death of a Eugene, Oregon newborn during a homebirth this July has revived debate over whether midwives should have to be licensed to practice in the state.

Among the 40 states that allow midwifery, the laws regulating them vary greatly.  Oregon and Utah, however, are the only states that have optional licensure of midwives.

It was to one of the unlicensed midwives, Darby Partner, that Eugene resident Margarita Sheikh turned to this summer when preparing to give birth to her son.

But tragedy struck as Partner and her assistant, Laura Tanner, were delivering Sheikh's son Shahzad.  He was born not breathing and attempts to revive him failed.

Sheikh said Partner initially ignored her requests to be taken to a hospital and that Partner and Tanner panicked when her infant was not breathing, arguing over how to perform infant CPR.  They eventually took Sheikh to a nearby hospital shortly after her son's birth but it was too late to save him.

Though Partner has more than a decade of experience, according to her online midwife profile, she does not have the optional state licensure nor certification as a professional midwife (CPM) that is offered by the North American Registry of Midwives.

Because unlicensed midwives are not regulated by the state, Sheikh cannot file a complaint against this midwife.

Now, Sheikh is calling for mandatory licensure of all midwives so her baby's death is not "for nothing."

Many midwives and advocates of midwifery contest the notion of mandatory licensure, arguing that it will not change the safety of home births.

"We're not in favor of mandatory licensure," said Susan Moray, press officer for Midwives Alliance of North America.  "We don't see that it makes a difference in birth outcomes.  It doesn't create more safety."

The alliance supports the CPM training, but hesitates to say that midwives need even that training because there are many qualified midwives with years of experience that have neither.  Instead, Moray said, women should look to standards of care set by the midwife community.

"We do peer reviews several times a year and ask the midwives how many births they've delivered, what complications they've handled, and which medications they can use," she said.  "I would encourage any woman seeking a midwife to ask the same questions."

Copyright 2011 ABC News Radio

Friday
May202011

Childbirth at Home on the Rise, Says Report

Creatas Images/Thinkstock(WASHINGTON) -- More women are opting to deliver their babies at home, according to new research published Friday in the journal Birth.

Using birth certificate data, researchers from the National Center for Health Statistics report they saw a 20 percent rise in home births between 2004 and 2008.

"I think there's a variety of reasons for the increase," said Marian MacDorman, a statistician and lead author of the report.  "The desire for a low-intervention birth in a familiar environment surrounded by family and friends, lack of transportation in rural areas, and cost factors could all factor in."

The total cost for a home birth, MacDorman said, is roughly one-third the cost of a hospital birth.  So for women who don't have insurance, delivering at home is cheaper.  On the other hand, not all insurers cover home births.

Another factor contributing to the rise in home births could be the simultaneous rise in C-sections -- the focus of the 2008 documentary, The Business of Being Born.  The film, produced by actress and talk show host Ricky Lake, suggests childbirth was transformed into a highly medicalized procedure in the twentieth century, citing reports that 95 percent of U.S. births took place at home in 1900.

Despite the hefty boost in recent years, home births still account for less than one percent of all deliveries.  And while acknowledging that the risks associated with home births are low, the American College of Obstetrics and Gynecology does not support the practice.

Copyright 2011 ABC News Radio

Thursday
May122011

Mothers Support Midwife Who Pleaded Guilty to Negligence During Delivery

Jupiterimages/Thinkstock (ALEXANDRIA, Va.) -- Karen Carr has won the thanks and praise of many moms by delivering more than 1,200 babies during her 25-year career as a midwife.

But last week Carr, 44, pleaded guilty to two felony charges in an infant death that she attended during a home delivery in Virginia last September. The state of Virginia argued that Carr was negligent during the home birth after the baby's head became entrapped for more than 20 minutes during the delivery. The baby died two days later.

Despite the charges and Carr's guilty plea, her fans still stand by her -- even raising money for her on a Facebook page created by In Service to Women, a group that supports midwifery and now hopes to help pay for Carr's legal fees.

Carr faced several charges, including involuntary manslaughter, according to the Washington Post. By pleading guilty, Carr accepted that her negligence contributed to the baby's death that and she was not licensed to attend a delivery in Virginia, the state that brought the charges against her.

It was the state of Virginia, not the parents of the baby who died, that brought the charges against Carr. The parents filed a request for confidentiality throughout the trial.

John Zwerling, Carr's attorney, said the parents were well aware of the risks involved with a vaginal breech home birth, but the mother was "desperate not to have a c-section."

Carr is a licensed midwife in Maryland but not in Virginia, which technically made it illegal for her to deliver the baby there.

"The hospital brought it to our attention, and we filed charges, brought by the Commonwealth," said Krista Boucher, chief deputy commonwealth's attorney in Alexandria, Va. "We were delighted that she acknowledged that she was criminally negligent in open court."

During the pregnancy, the baby was in a breech position, and the parents hired Carr to attend the home delivery. In the breech position, babies enter the birth canal feet -- or buttocks -- first, not head-first.

The baby boy's head was stuck for nearly 20 minutes before it was pulled out. Carr performed CPR, but the baby was soon transferred to Inova Hospital in Alexandria and died two days later, according to court documents.

"Breech deliveries, in general, are done by Caesarean section for exactly the reason that happened in this case," said Dr. Jacques Moritz, director of gynecology at St. Luke's-Roosevelt Hospital in New York City. "The chance of head entrapment is small, but when it happens, it is devastating."

Moritz was quick to note that breech births can be difficult in hospitals, too, but "there are more things you can do in a hospital" to fix it.

"I'm as midwifery-friendly as they come, but a breech home delivery is just stupid," said Moritz, who was featured in the pro- midwifery documentary The Business of Being Born.

When head entrapment does occur, Dr. Manuel Porto, professor and chairman of obstetrics and gynecology at the University of California Irvine Medical Center, said there are a series of procedures available.

Patients interested in midwifery are informed of the benefits and risks before deciding on a home birth. Licensed midwives are trained in normal patterns of labor, Moray said, but if something becomes abnormal during the delivery, the midwife transfers care to physicians.

Had the mom in Carr's case been in a hospital, Moritz said, doctors probably would have performed a C-section to take out the baby, or, if the head was stuck while trying to deliver vaginally, special forceps could have been used to pull the baby. Midwives do not have such tools available to them.

When asked whether the outcome would have been different in a conventional hospital setting, Porto responded, "Yes, with little doubt."

Despite it all, Carr's backers still sing her praises. The Facebook page contains messages that express thanks and support from mothers who hired Carr as their midwife.

"Karen was such a blessing in my first pregnancy and birth that I went on to have 2 more homebirths," one woman wrote. "The peace and words and knowledge she shared with me -- I continue to share with other expectant mothers."

Copyright 2011 ABC News Radio 







ABC News Radio