Home birth supporters seek to ease midwife rules
Some say requirements in Maryland too restrictive, others argue safety is an issue
Maya Brennan holds her 8-week-old daughter Asta, who was born in the family's home. (B581853720Z.1, Baltimore Sun / January 26, 2012)
Home births are on the rise in the United States with deliveries jumping 29 percent between 2004 and 2009, according to data by the Centers for Disease Control and Prevention released last week. Maryland home births increased at an even more rapid clip of 62.5 percent.
But supporters of home births say that Maryland still places too many restrictions on obtaining a midwife, and they have started a grass roots movement to ease the standards. They are working with a Montgomery County delegate to introduce legislation that would open the door to more midwives delivering babies at home.
"The climate in this state toward home births is unfriendly and it made us want to try and do something about it," said Jeremy Galvan, a Hagerstown dad and paramedic whose son was delivered at home. Galvan recently helped found the group Maryland Families For Safe Birth to help make it easier for families to have home births.
State health officials, citing safety concerns, oppose loosening the restrictions. They issued a joint statement late last year reaffirming their view — and state law — that certified nurses or doctors must be present during home births. Heightening concerns in the medical and health community is the high-profile case of Karen Carr, a Maryland midwife who was convicted of two felonies last year after the death of baby boy she was delivering in an Alexandria, Va., home.
The joint statement was issued by the Maryland Department of Health and Mental Hygiene, the state's nursing board, the association that represents county health officials, and the Maryland affiliate of the American College of Nurse-Midwives.
"At this point it is a safety issue," said Fran Phillips, DHMH deputy secretary for public health. "It makes a world of difference if you have someone who has the right skills, right equipment and has a link to the hospital if something goes wrong."
Heather Brown, 35, of Pikesville, delivered two of her babies at home, including a daughter born seven weeks ago. She said state officials need to be more open-minded about home births.
"It should be a valid choice for women who want to do it," she said. "It should be a woman's choice and not the doctor's and the medical establishment. It's not fair for the government to make it so difficult."
Home births are not new in the United States. In the early 1900s, until the creation of the modern day hospital, homes were the primary place where babies were born.
Today, such births are rare, making up less than 1 percent of all births nationwide and in Maryland. But they have re-emerged somewhat in the past decade as some women seek a more personal birth experience, without all the machines and tubes of a hospital setting. The CDC data showed that white women over age 35 who already have several other children are leading the trend in increased home births.
The issue of home births often pits the medical community and midwives against one another. Doctors and health officials often argue that people who deliver babies need an extensive medical background in case complications arise. Midwives, meanwhile, defend their qualifications and say there are no studies that show home births are any less safe than those in hospitals.
Under Maryland law, only a midwife with a certified nursing license can deliver babies in a home setting and they must collaborate with an obstetrician gynecologist. The majority of home births around the country, 43 percent, are performed by other types of midwives, including certified professional midwives, who Maryland does not allow to deliver babies at home. Certified professional nurse midwives have training in childbirth like other midwives, but specialize in out-of-hospital settings and must get a certification.
Parents say strict standards in Maryland are limiting home birth options and leading to unsanctioned home births, performed by midwives that mothers and other states say are qualified, but that Maryland refuses to license.
State officials issued the joint statement partly because birth certificate data from local health departments showed that more women may be using unlicensed midwives. An increasing number of parents who ask for birth certificates are telling health officials that no one assisted them in their home birth. That is sometimes a sign parents are trying to protect midwives without licenses.
Even nurse midwives — who can legally deliver babies in homes — say there are problems in Maryland.
Bayla Berkowitz works as a nurse midwife at CNM & Associates at Mercy Hospital in Baltimore. She said the practice associates with a hospital in part because it is difficult to do home births in Maryland. The practice tries to instead recreate the home setting in hospital rooms at Mercy.
"For legal reasons it's easier to [associate with a hospital] in Maryland," she said.
Mairi Breen Rothman, a nurse midwife based in Takoma Park, said it is hard to find a doctor to collaborate with. For years she practiced only in Washington, D.C. Doctors would work with her in Maryland because they feared liability issues, she said.