Caring for women, with comfort, safety and quality…. a birth home!

Global Birth Home/Center Definition

A birth home is a physical facility reflecting a local woman’s home-like environment, that is separate from CEmONC[1] facility and, when in a low resource area, meets BEmONC standards of care.

Providers are skilled birth attendants, usually midwives, as defined by WHO/ICM,[2],[3].

The philosophy of care provided is the midwifery wellness model of care for healthy women with normal labor, birth and support. Continuous risk assessment is done throughout her care to assure appropriate level of care is provided.  The midwifery model of care specializes in low medical intervention and high comfort, “a high touch, low tech approach”, reinforced by care dependent on relationships and community, involving time, education, personal attention and trust.

The “program of care” required to do this is a relationship driven care model, often including such things as childbirth education, support groups, breastfeeding education and support, nutrition and health education, community outreach, centering pregnancy, family planning and GYN care to meet a particular community’s needs.

A birth center is committed to a woman’s health safety, personal safety of staff and woman, cultural safety and community safety as demonstrated through standards of care.

The birth center is rooted in a woman’s local community, working with local health care providers, and is part of the larger health care system, working with the community’s CEmONC through drills, education and communication to facilitate high quality of care, collaboration and transfers of women as needed, directly and easily.

“a skilled attendant is an accredited health professional — such as a midwife, doctor or nurse — who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns.  Core midwifery skills have been defined by the International Confer deration of Midwives in a document entitled Essential Competencies for Basic Midwifery Practice, available at http://www.internationalmidwives.org1
“Types of skilled attendants and the mix of skills and abilities While it is up to each country to decide on how maternity care should be organized, much depends on the availability of skilled attendants, the composite set of skills and abilities they possess and the resources available to recruit, train and retain these staff. The principal categories of skilled attendants found in many countries include:
Midwives (including nurse-midwives): Persons who, having been regularly admitted to an educational program duly recognized in the country in which it is located, have successfully completed the prescribed course of studies in midwifery and acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery.
Nurses with midwifery skills: Nurses who have acquired midwifery knowledge and skills either as a result of midwifery being part of their nursing curricula or through special post basic training in midwifery.
Doctors with midwifery skills: Medical doctors who have acquired competency in midwifery skills through specialist education and training, either during their pre-service education or as part of a post-basic program of studies.
Obstetricians: Medical doctors who have specialized in the medical management and care of pregnancy and childbirth and in pregnancy-related complications, but not usually complications of the newly born infant. They have usually undergone additional education and clinical training to acquire these additional skills and have been certified or accredited in obstetrics.”2
[1] BEmONC provides: parenteral antibiotic, oxytocin and anticonvulsant drugs, manual removal of the placenta, removal of retained products of conception and assisted vaginal delivery (vacuum delivery) as well as basic newborn resuscitation and care.  CEmONC provides: BEmONC level care and cesarean section and blood transfusion. http://pdf.usaid.gov/pdf_docs/PA00JX4F.pdf
[2] http://www.who.int/reproductivehealth/skilled-birth-attendant/en/
[3] http://apps.who.int/iris/bitstream/10665/42955/1/9241591692.pdf

Where are all the midwives and what are they doing?

Today I read an interesting blog by Theologian Mom . In it she discussed the difficulty she had in trying to find a birth center and then a midwifery practice close enough to her. You’d think she lived in a large rural state, but in fact she lived in New Jersey. It got me to thinking about what midwives do and where they are doing it. Well, at least CNM/CMs.

I work in PA and there are plenty of non nurse midwives doing home birth all around me. Many of them very good. But some, unlicensed in PA, well lets just say I wouldn’t feel comfortable going to them. But home birth midwives, no matter who they are represent a midwifery group that is rarely seen. They challenge the status quo by their existence, but in reality most of maternity care doesnt even know who they are or what they are doing or how many. They are invisible by the nature of home birth.

So I decided to look up a few stats. The latest CDC report from 2006 lists a total of 4,265,555 births, 3,905,146 (91.5%) by physicians and 336,347 (7.8%) by all midwives. Of those 4,226,624 (99%) occurred in hospitals, and 38,568 (1%) out of hospital. 97% of CNM/CM delivered in hospitals, 2% of them delivered in birth centers and only 1% delivered at homes. 39.7% of all out of hospital births were done by other midwives.

So, another good question is, who are all these hospital based midwives working for? I searched all over the ACNM website and could not find that out. My guess it that not too many of them worked for themselves.

Why does this matter? If we are looking for a social change, a paradigm shift in maternity care, we must have an impact. We need to make mainstream maternity care think about what they are doing and that there are many ways, safe ways, to have a baby. When we are at home (and my last baby I had at home) we actually are hiding away. Now as the mom, I knew it was what I needed to do, but now as a midwife, I know I need to do more.

There are not enough midwife entrepeneurs, not enough midwife run practices and not enough birth centers!  How can we change maternity care if we can’t even have a midwifery run practice?  I know there are some very supportive OBs out there, I even am lucky enough to work with one.  But the bottom line is, Midwives and OBs are different, we have a different model of care and no amount of “support” can replace that.  Midwifery education needs to talk business, they need to talk public health and help create a new generation of midwives ready for the change coming in health care.