Homebirth and Midwifery
A Gentle Birth Option
Recently, Missouri became the 28th state to allow midwives to practice the art of homebirth midwifery. In July 2008, Missouri joined these other states across the nation in supporting a woman's right to choose the site of her birth and a credentialed care provider. The CPM credential, or Certified Professional Midwife Credential is issued through NARM (North American Registry of Midwives). The CPM credential focuses on developing core competencies and standardized testing for midwives practicing in an exclusively out-of-hospital setting.
CPMs are not lay midwives. "Laypersons" implies an ignorance of lack of training in a specialized field of knowledge. By contrast, CPMs are specifically trained in the management of low-risk pregnancy and birth, and in the differentiation of low risk versus high-risk pregnancy. The CPM, unlike the doctor or nurse midwife, must attend a majority of the clinical component required for her certification in an out-of-hospital setting, either at home or in a free standing birth center.
The CPM respects the natural process of birth and the wisdom of nature in designing the birth process. She is also a professional. A CPM will not only provide support for labor, but she will monitor fetal heart tones with a Doppler or fetoscope, check for cervical changes, chart findings and safeguard the normalcy of the process.
Depending on the laws of her state and her standard of practice, she will usually also carry oxygen and newborn resuscitation equipment, anti-hemorrhagic drugs such as pitocin and IV and suturing equipment. The CPM works to judiciously balance the most useful tools of modern practice with the wisdom and gentleness of natural birth.
Is homebirth right for you?
Homebirth is an excellent option for low-risk mothers-to-be. However, women experiencing pre-term labor or other complications of pregnancy such as preeclampsia, as well as those with underlying health problems such as heart, lung or kidney disease, are best cared for in a hospital by an obstetrician.
Homebirth midwives use a variety of methods to decrease discomfort and during labor and often find that just the comfortable and familiar setting of home is enough to significantly increase the effectiveness of pain relief measures such as breathing and positioning. Homebirth midwives do not, however, use pharmaceutical pain relief measures or epidural medication in labor. Therefore, mothers-to-be contemplating homebirth should be prepared for a completely natural labor and birth.
How will my homebirth proceed?
If you choose a homebirth, your first step should be selecting a midwife. Most midwives offer a free consult visit. She will probably ask that you bring a prepared list of questions so that you may make the most of your time in the visit. Good questions to include are those about background, experience and credentials, as well as the midwife's availability, philosophy of birth and equipment.
Once you have selected a midwife she will probably see you on a schedule similar to that set by obstetricians and nurse midwives. She will assess the normalcy of your pregnancy with blood pressure, fetal heart tones, fundal height measurement, weight and urinalysis. If everything remains within normal limits, when you reach term your midwife will discuss with you when to call her. She will probably do a prenatal visit at your home at this point, if she has not already, so that she can find her way more easily and see where you plan to give birth. When you go into labor you will contact your midwife as you have discussed.
Your midwife will come to your and be with you during a majority of your labor, birth and several hours into your postpartum. One of the wonderful benefits of homebirth is that you and your baby will not need to be separated and the newborn exam is usually done right next to mom at the bedside.
Once you and your baby are settled and comfortable, your midwife will leave instructions for caring for yourself and your baby. She will be continue to be "on call" for your needs until your next postpartum visit. This is also usually at your home so that you and your baby can continue to rest, bond, and build a healthy future from your beautiful birth experience.