Hundreds of mothers and fathers marched on Raleigh Wednesday with babies strapped to their backs and toddlers in tow. After making their way through the halls of the General Assembly, they set up picnic blankets and lawn chairs in front of it, where they sat waving signs that read “Legalize My Midwife,” “Liberate Labor,” and “Born at Home.”
The parents were recognizing the International Day of the Midwife as they petitioned lawmakers to restore what they see as the right to bring their babies into the world naturally, in the privacy and comfort of their homes, with the assistance of a midwife.
It’s a tradition that went underground in North Carolina in 1983, when the state decided to make it illegal to practice midwifery without a nursing degree. While it is not illegal for a woman to deliver a baby at home, it is illegal for a midwife to be present when it happens. Since few doctors make house calls and midwives aren’t allowed to, women who refuse to have their babies in hospitals are left with few choices: Go it alone, leave the state, or break the law.
While many medical professionals argue that home births are inherently less safe than hospital deliveries, midwifery could emerge from the shadows if House Bill 522, now awaiting a hearing in the House Health and Human Services Committee, becomes law.
An estimated 600 women have their babies at home in North Carolina each year, while another 300 cross state lines to find midwifery services, said Russ Fawcett, a board member of North Carolina Friends of Midwives.
Similar legislation has been proposed for more than a decade, but the debate gained immediacy this year after the recent arrest of a popular midwife.
Meet Amy Medwin
Amy Medwin is a certified professional midwife, with a license to practice midwifery in Virginia, but not in her hometown, just north of Winston-Salem.
Medwin sought out her “calling” as a midwife, shortly after giving birth to her first child in a hospital 37 years ago. It was a “terrible” experience, she said. She spent nearly 36 hours in painful labor, which she attributes to “unnecessary” drugs and stress.
Back then, only the mother and other medical professionals typically were allowed in the delivery room. Medwin had to fight to have her mother in the room with her.
Shortly afterward, Medwin attended her first home birth, as an apprentice to a trained midwife. “It was so triumphant,” she said. “Here she was in her own bed. Nobody took her baby away from her. Her breastfeeding was never interrupted. The baby was never removed from the loving arms of its parents.”
Medwin has helped deliver more than 1,000 healthy babies over the last 30 years. She never has had one complaint. Her clients call her a “miracle worker.” But Medwin cannot raise babies from the dead.
Last February, a baby was stillborn. Medwin was not present for the delivery, nor was she the mother’s primary caregiver, but she had tended to the woman — a close family friend — at times during her pregnancy.
At 8 a.m. one morning, the pregnant mother went into labor. Within 45 minutes, the baby was delivered, before the mother had time to go to the hospital and before a midwife could have arrived. The baby wasn’t breathing and had no heartbeat.
The family took the baby to the hospital, Medwin said, where police said she had been negligent because she couldn’t prove she’d had prenatal care. Medwin came as a witness to say that the mother did receive prenatal care — just not from a licensed obstetrician — and when police learned Medwin was a midwife, they arrested her.
The family is not pressing charges against Medwin. Still, Medwin faces charges of practicing midwifery without a license.
Ladies in waiting
While Medwin’s court case is pending and legislation legalizing midwives hangs in the balance, many of the 30 certified professional midwives in the state have put their practices on hold. The dozen or so who still practice are doing so much more cautiously, fearing they could end up in jail.
Several pregnant women in attendance at the rally Wednesday said Medwin’s arrest has put them in a precarious position.
“I am stuck,” said one pregnant woman. “I don’t know what I’m going to do.”
“I could drive out of state,” she said, “I could have the baby at home alone,” or “I could beg a midwife to help me, but they are taking a huge risk at this point.”
The woman said it would have to be one of the three, though, because “going to the hospital is not an option for me.”
Fawcett said North Carolina is the most restrictive state in the Southeast when it comes to midwifery services. South Carolina, Virginia, Tennessee, and Florida all license CPMs.
The number of American women choosing to give birth at home is growing. In North Carolina, the home-birth rate increased 32 percent between 2003 and 2006. Of the women who have their babies at home, 60 percent choose to use CPMs, rather than nurse midwives, who are hard to come by and who have a slightly different philosophy about birth.
So while demand for CPMs is increasing, supply in North Carolina is decreasing, Fawcett said.
The North Carolina Obstetrical and Gynecological Society opposes the licensure of certified professional midwives.
“When you step out of the hospital or a certified birthing center and go into the home, you’re stepping back into the 19th century,” said David Barnes, a lobbyist for the association. “You don’t have the equipment a modern hospital would have in case something went wrong.”
There’s no such thing as a low-risk birth until it’s over with, Barnes said.
“Something can go bad very quickly — like hemorrhaging — and if you’re not within five minutes of a hospital, bad things can happen,” he said.
Barnes said obstetricians and gynecologists think the training CPMs receive from the North American Registry of Midwives is inadequate and does not measure up to the training nurse midwives (who mainly work in hospitals) receive. The society does not support home birth whether it’s with a CPM or a nurse midwife, Barnes said.
The American College of Obstetricians and Gynecologists reports that planned home births are two to three times more likely to end in fetal mortality than planned hospital births.
Fawcett disputes this statistic, saying infant mortality rates at home and in the hospital are almost identical, while instances of cesarean sections and other interventions are much lower in the case of planned home births.
“This is not about competition,” Barnes said. “This is not about money. It’s about their professional opinion about what’s safe and what the public policy ought to be.”
But home birth moms and dads maintain that it’s not up to physicians to decide what’s safest for their babies, it’s up to them.
Rep. W.A. “Winkie” Wilkins, D-Durham, said choice is the reason he sponsored H.B. 522. Wilkins sat on a midwife licensure study committee in 2008 and for him it all came down to one question – “If we don’t license you, what are you going to do?”
“We’re going to keep on doing what we do,” the midwives told him.
“So I want to know who and where they are,” Wilkins said.
Medwin said licensure is the only compromise midwives and the state could agree to, and she’ll take it over jail. She said the ultimate goal is increasing access to care for women.
The bill awaits its first committee hearing, and Fawcett is optimistic about its passage.
Sara Burrows is an associate editor of Carolina Journal. Contributor Hal Young provided additional reporting for this story.