Article more women should give birth outside of hospital

[huckleberry08]

I saw this on NPR's site when I woke up this morning. I think the title is misleading, as it seems like the suggestion is for more women to use midwives and birthing centers as opposed to, say, giving birth at home. I haven't actually seen the UK recommendations, however.

[lioness13]

I love my OB but I would totally consider giving birth at a birthing center with a midwife. The main midwifery clinic here hasn't gotten the best reviews because there are so many rotating on staff that women don't feel they get personalized care. If that wasn't an issue I would totally use one. My hospital experience was just okay (besides the awesome water they have).

[momofcatan]

I tell everyone that if I didn't LOVE my OB I would have gone with a midwife this time around (still hospital birth, but we only just got a birthing centre here). It's funny how when I say this, anyone over the age of 35 looks at me like I'm nuts and anyone under the age of 35 agrees.

I remember the girl from Australia saying everyone there goes to a midwife unless you are high risk. I wonder if in countries where this is the norm the training for midwives is a little better/more like med school? I know someone on here mentioned to me there are differences in the training/certification for midwives between the US and Canada.

[kh59]

The statistics in this article make me feel like I must live in a pretty weird little bubble, because I know three other women in my neighborhood that have recently used the same homebirth midwifery practice that I'm seeing now. Two others used the hospital birth midwifery practice that I used with my first birth. Apparently I live in a crazy hippie enclave? I had no idea. Or maybe I'm just fortunate to live in a place that has multiple highly experienced CNMs? What we don't have is a birth center in our area, which would be my first choice.

[huckleberry08]

Midwives are integrated into our practice but they deliver at the hospital. There is always an OB present on the floor, along with multiple obstetric and CNM residents. Our hospital is working toward a Baby Friendly designation, though, so I felt more like I could have the delivery I wanted while still being monitored and getting the antibiotics that I needed. They are talking about opening up a nearby birthing center, but I guess my personality type is such that I want a Level IV NICU down the hall from me. If that came with more pressure for medical intervention, though, I may change my tune.

[anustart1]

I didn't really have an option where we lived for a good birth center or midwife practice with G and I ended up needing a C-section anyway. I would have loved to try a birth center delivery with Lo if it wasn't for the fact that no midwife or birth center based practice here (of which there are many to chose from) would allow me to try a VBAC outside a hospital. Given it was my first VBAC I felt much more comfortable in a hospital. That being said my hospital VBAC was as close to a homebirth as I could get- no interventions or meds, only a midwife in the room the whole time and DH actually delivered Lo. If I ever trick DH into a third I would love to try a homebirth, but I'm literally a little scared by needing a plastic surgeon to stitch me up after and I wouldn't want to risk losing my lady bits!

[anustart1]

Jul 13, 2015 14:37:55 GMT -5 huckleberry08 said:

Midwives are integrated into our practice but they deliver at the hospital. There is always an OB present on the floor, along with multiple obstetric and CNM residents. Our hospital is working toward a Baby Friendly designation, though, so I felt more like I could have the delivery I wanted while still being monitored and getting the antibiotics that I needed. They are talking about opening up a nearby birthing center, but I guess my personality type is such that I want a Level IV NICU down the hall from me. If that came with more pressure for medical intervention, though, I may change my tune.

My first hospital was one of the first "Baby Friendly" hospitals in the US, so I had a pretty darn hippie dippy C-section experience. I LOVED them for it though- Level 4 NICU with all the crunchy granola options!

[sympkin]

This is near and dear to me.

Honestly, I think in my perfect scenario of the "birthing picture" all births would occur in a birthing centre. It would be very similar to today's birthing centres only there would also be a surgery. Midwives would be primary for everyone with OBs on call.

I think this would tackle two of the major problems of overreaching care and hospital acquired infections. I think with infections and antibiotic resistance on the rise we seriously have to reconsidered the practice of bringing otherwise healthy but at risk people into a building full of sick people. My SIL had to give birth in hospital full of SARS patients, it's ridiculous.

Anyways, I think it would be safe, comfortable and cost effective. The problem is no hospital is going to give up hospital admissions for birth and delivery without a fight because it is a huge money maker for them. Even in Canada where profit generally isn't much of a motivator as hospitals love their delivery wards and NICUs because they get so many donations because of them.

[sympkin]

momofcatan, I think @coffeeismylyfe, summed up the mess pretty well. The ones who have the best education standards in the states are CNM (Certified Nurse Midwives) and they are the ones who are closest to the education midwives in Ontario receive. The problem is they generally can only practice in hospitals.

So it can be a little aggravating when people complain that homebirth isn't safe when they are purposefully making it less safe by only having lesser trained people out in that field.

[momofcatan]

Jul 14, 2015 9:04:04 GMT -5 sympkin said:

momofcatan, I think @coffeeismylyfe, summed up the mess pretty well. The ones who have the best education standards in the states are CNM (Certified Nurse Midwives) and they are the ones who are closest to the education midwives in Ontario receive. The problem is they generally can only practice in hospitals.

So it can be a little aggravating when people complain that homebirth isn't safe when they are purposefully making it less safe by only having lesser trained people out in that field.

That's interesting. The comments made me wonder. Is a home birth by a midwife covered by OHIP? I would assume yes, since I assume a midwife gets to bill OHIP just like a Dr would (i guess like a house call dr), but I actually have no idea how it works.

[sympkin]

Jul 14, 2015 9:13:35 GMT -5 momofcatan said:

Jul 14, 2015 9:04:04 GMT -5 sympkin said:

momofcatan, I think @coffeeismylyfe, summed up the mess pretty well. The ones who have the best education standards in the states are CNM (Certified Nurse Midwives) and they are the ones who are closest to the education midwives in Ontario receive. The problem is they generally can only practice in hospitals.

So it can be a little aggravating when people complain that homebirth isn't safe when they are purposefully making it less safe by only having lesser trained people out in that field.

That's interesting. The comments made me wonder. Is a home birth by a midwife covered by OHIP? I would assume yes, since I assume a midwife gets to bill OHIP just like a Dr would (i guess like a house call dr), but I actually have no idea how it works.

Yep, all OHIP here in Ontario. It's similar to any transfer of care. I just handed over my health card, gave them my GPs info and they handled the rest

[momofcatan]

Jul 14, 2015 9:28:38 GMT -5 sympkin said:

Jul 14, 2015 9:13:35 GMT -5 momofcatan said:

That's interesting. The comments made me wonder. Is a home birth by a midwife covered by OHIP? I would assume yes, since I assume a midwife gets to bill OHIP just like a Dr would (i guess like a house call dr), but I actually have no idea how it works.

Yep, all OHIP here in Ontario. It's similar to any transfer of care. I just handed over my health card, gave them my GPs info and they handled the rest

Definitely a UO with some people IRL, but I love OHIP.

[kh59]

Jul 13, 2015 17:05:56 GMT -5 @coffeeismylyfe said:

Jul 13, 2015 13:05:31 GMT -5 momofcatan said:

I tell everyone that if I didn't LOVE my OB I would have gone with a midwife this time around (still hospital birth, but we only just got a birthing centre here). It's funny how when I say this, anyone over the age of 35 looks at me like I'm nuts and anyone under the age of 35 agrees.

I remember the girl from Australia saying everyone there goes to a midwife unless you are high risk. I wonder if in countries where this is the norm the training for midwives is a little better/more like med school? *I know someone on here mentioned to me there are differences in the training/certification for midwives between the US and Canada.*

The starred Is a large part of the problem. There is more than one type of certification for midwives just in my state, let alone the US at large. And each state varies as far as what type of midwifery is legal, if it's legal at all. It has only been legal in my state for seven years for any midwife to practice, and even now most CNMs won't do homebirths because they can end up losing their RN for "practicing beyond the scope of their license." Even though their license is supposed to allow them to deliver babies! That leaves most homebirths to direct entry or CPMs which REALLY vary from midwife to midwife as far as the type of care you might recieve. I think as a whole homebirth would be a lot safer in the US if it were more accepted and tuned in with hospitals and if CNMs were not facing potential career ending consequences for practicing outside of a bc or hospital.

The variation state to state is pretty crazy.  My homebirth midwife is a CNM, and she has had quite a few patients who have been successful in getting insurance coverage.