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Inglis: Homebirth controversial

BY MCCULLOUGH INGLIS | OCTOBER 11, 2012 6:30 AM

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When my little sister was born, she came out blue. Recognizing her inability to breathe because of fluid in her lungs, the doctors immediately pumped her lungs and put her on oxygen. Within four hours, my little sister was back by my mother’s side, breathing on her own.

When my mom’s best friend began to give birth at home, her placenta detached too soon, and her son’s oxygen source was cut off as a result. Her midwife rushed her to the hospital, but by that time, her son’s brain had been deprived of oxygen for too long. He developed epilepsy as a result.

Iowa is one of 10 states where legislation is being introduced this year to legalize Certified Professional Midwives. As of now, only Certified Nurse Midwives can attend home births, and to do so, they must hold a bachelor’s degree, an active Registered Nurse license and receive accreditation from the American College of Nurse-Midwives.

If the bill in the Iowa Legislature passes, however, Certified Professional Midwives will be able to attend Iowa home births. To be licensed, they must have a high-school diploma, complete an apprenticeship program, and receive a certificate from the North American Registry of Midwives.

The popularity of home births is on the rise across the country. During the five-year period from 2004 to 2009, the percentage of American births that occurred at home rose by 29 percent, according to the Centers for Disease Control and Prevention. With this increase, an intense debate about the safety and philosophy of home versus hospital births has surfaced, but local news outlets such as The Daily Iowan and the Gazette have chosen to focus on the cultural phenomenon of home births rather than the medical issues at hand.

Proponents of home birth contend that having children at home allows nature to take its course. Women can avoid the interventionist approach hospitals take, where more than one in four births end with a cesarean section and the use of forceps and vacuums , which occurred in 3.62 percent of all births in 2010, according to the U.S Department of Health and Human Services. As a result, proponents like the local Eastern Iowa Midwives note that midwives’ “major specialty is normal,” while obstetricians’ are trained in pathology and abnormality.

Meanwhile, opponents of home birth cite a study published in the Journal of Obstetrics and Gynecology, in which the authors concluded that home birth tripled the rate of neonatal death.

Local opponents such as the Iowa Medical Society point to the drastic difference in caregiver credentials. While doctors must have four years of undergraduate study, four years of medical school, and three to four years of supervised clinical training in residency, Certified Professional Midwives (which are different from Certified Nurse Midwives) may be licensed with as little as 240 hours of clinical training.

Both groups cast aspersions on each other’s data and motives, and the truth seems difficult to sort out from differing data contradicting each other on home births. Regardless, it is essential to treat the rise in home births not simply as a cultural phenomenon or a question of a mother’s agency over her body but as a life-changing medical choice.

As it stands now, Iowa City mothers have the option to give birth with a Certified Nurse Midwife in the University of Iowa Hospitals. If an emergency arises — and they can arise in seconds — a team of highly skilled doctors and state-of-the-art medical tools are within the same building, ready to respond.  

If this bill passes the Legislature, however, more women may face the drive to the hospital my mother’s friend faced. Given the precious nature of every child, it seems hardly worth the risk.


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