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Sunday
May222011

White Ladies Love Them Some Homebirths; Meanwhile, Midwives Win in Colorado

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By Emjaybee

These two articles came my way this week and I thought they were both interesting.

First, USA Today posted an article on the rise in homebirth that included this interesting turn of phrase:

Home births rose 20% over four years, government figures show, reflecting what experts say is a small subculture among white women toward natural birth.

The article has some good numbers overall and is worth a read, but that line gave me pause; why is race being called out so specifically? I would guess the AP writer was just looking for an interesting hook to hang his or her story on. But it comes across as though the reader were being reassured that hey, it’s just a small subculture of white women doing something weird, not any kind of big change to see here…don’t worry, America!

Meanwhile, in a post about the legislative victory in Colorado for direct-entry (CPM) midwives (who appear to serve all or mostly homebirth clients in Colorado) Radical Doula writes:

In political environments that are often very midwife unfriendly, these battles can be particularly challenging. Midwives are afraid if they push too hard, they might lose altogether and no longer be able to practice in the state. So often what results is compromise laws that can severely limit the midwives’ ability to practice as they are trained to do.

Indra [Lusero]’s group [Delivering Natural Care for Families] though, presented a different advocacy effort–that of consumers, not the midwives themselves. Their stake in the fight is different, and can be received by elected officials in new ways…

…Here are a few of the changes they were able to achieve:

  • Registered CPMs can now be simultaneously licensed as nurses (and vice versa). This was prohibited in the original law.
  • Registered CPMs can now obtain and use these drugs: Vitamin K, Rhogam, antihemorrhagic drugs, and eye prohylaxis.
  • The language that spoke negatively of midwifery was removed.

She also linked to this piece on Ms. Lusero’s personal battles to have homebirth and aid midwives, which is fascinating and inspirational in its own right; my favorite part of it, though, was this capsule history of Colorado midwifery:

In 1917, under pressure from doctors, Colorado enacted a law requiring midwives to pass an exam and apply for a license in order to attend births. In addition, midwives were forbidden to use any instruments to deliver babies or administer any drugs. Despite this, many babies were still born at home. But in 1941, state lawmakers passed a law preventing any more midwives from obtaining licenses; already-licensed midwives could continue to practice, but no new ones could join the field. It was an attempt to make midwifery disappear, and though the number of babies born in hospitals skyrocketed in the 1950s, the law didn’t completely succeed. Midwifery just moved underground.

The profession experienced a national resurgence in the 1970s, fueled by feminism, the burgeoning health-rights movement, and government reports that anesthetizing women during childbirth could harm their babies. In Colorado, nurse-midwives — nurses who specialize in midwifery and deliver babies under the supervision of a doctor, often in a hospital — won legalization in 1977. A group of so-called lay midwives — midwives who deliver babies at home without medical intervention — wanted the same thing. They’d been practicing off the radar for decades, risking arrest and charges of practicing medicine without a license. In 1979, they formed the Colorado Midwives Association in Boulder.

For the next several years, they fought to legalize their profession. “We threw ourselves against the state legislature again and again,” says Jennifer Braun, a midwife who started practicing in Boulder in 1982 and now runs a nonprofit called International Midwife Assistance that offers birth services in Uganda. “It was a David and Goliath story.”

Bills to regulate lay midwifery failed in the legislature in 1983, 1984, 1985 and 1991. Each time, doctors, nurses and even nurse-midwives testified against them, arguing that delivering babies at home was unsafe. Meanwhile, supporters said that women were going to give birth at home regardless of whether it was legal. State regulation of midwifery would make it safer, they argued, not the other way around.

In 1993, after several midwives were arrested and one case reached as high as the Colorado Supreme Court, the legislature finally agreed. The resulting law decriminalized lay midwifery and set up a process by which “direct-entry midwives,” as they are now called, could register with the state Department of Regulatory Agencies, or DORA. The law directed DORA to set education standards and rules for when midwives could and could not provide care, as well as a disciplinary process for when they broke those rules. The law also protected doctors and nurses from liability for a midwife’s “mistakes.”

It was a victory, but an imperfect one. The resulting rules included several restrictions: Midwives could not care for pregnant women with diseases such as diabetes, sickle-cell anemia or hepatitis. Midwives could not suture. Midwives could not administer common pregnancy-related drugs. Midwives could not deliver breech babies or twins.

The legislature also set a date — July 1, 1996 — to review the law and decide whether it should continue, in accordance with Colorado’s sunset process. The 1995 sunset review report, written by DORA, illustrates that the attitude toward midwifery in Colorado was still hostile. Even so, DORA recommended that the profession continue to be legal.

Speaking of white women (we were, right?) Delivering Natural Care for Families was aided by COLOR, the Colorado Organization for Latina Opportunity and Reproductive Rights as a “lead coalition partner.”  COLOR was also instrumental in getting a law passed banning the use of shackles on incarcerated women during birth.  I thought it would be nice to call out COLOR and thank them for the good work they appear to be doing for all the women of Colorado, regardless of subculture size. 

 

More reading:

Guest Post: We Need a Movement

New Study Identifies Need to Distinguish Planned from Unplanned Home Births

Stuff White People Like: Talking About Birth

Convincing White Women that Birth is Painless Will End ‘Race Suicide’

 

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Reader Comments (39)

I also read that ABC article in which the phrase "a small subculture of white women" who are accessing home birth midwifery care was used. Although all kinds of women use midwives, it is an unfortunate fact that many states do not reimburse medicaid expenses for midwifery care, for either CNMs or CPMs. Also to note, that a disproportionate number of women of color rely of medicaid for their health care due to systemic racism that falls outside of just the medical practice. I think it is important to understand why that it is a majority of white, upper-middle class, educated women who are seeking out midwifery care. It is because many white women have the means to pay out of pocket for expenses not covered by their health insurance and it is important to mention. I wish the author of the article had explained why the stats are this way, but getting the mainstream media to talk about racism and white privilege is generally a long shot ;)

As a future (white) midwife, I believe it is imperative to continue to examine the privileges that many of us have in order to understand and begin to solve problems of racial gaps in accessing midwifery care and maternal and infant mortality.

May 23, 2011 | Unregistered CommenterMichelle

I too was perplexed by the not-so-implicit characterization of home birth of something that white women in "the natural birth subculture" are doing more and more. Just using the term 'subculture' makes this seem more like a caricature than a legitimate characterization.

(I haven't done the work to find this out, but I wonder if home birth rates did, in fact, rise among non-white women too. And yes, I question the motivation of calling on race specifically without adding any analysis to the discussion. Hmph.)

May 23, 2011 | Unregistered CommenterKristen

It certainly gave credence in the eyes of some of my friends and associates (who themselves are black, like me) who said my choice to birth at home came from hanging out with too many rich or granola type white women. They pointed this article as back up and the implications by both them and the article really bother me.

For the record I personally know very few "granola type" women and hang out with even less than that. As for the rich part...that just makes me laugh.

May 23, 2011 | Unregistered CommenterPatrice

I thought about that when I saw the USA today article also- I thought, the only reason that I did not birth at home (not rich white person here) is because I couldn't afford it, or thought that I couldn't. Probably it would have been about the same price in the end, but I think that the reason why more women don't consider home birth is because they don't have a choice. They are dependent on the system to pay for their health care, and that means a hospital.

May 23, 2011 | Unregistered CommenterSara

Jill,

Yes, the legislation in Colorado is a victory for CPMs, but it is a loss for babies.

Colorado licensed midwives have been required to submit their statistics for each of the past 4 years and the results are nothing short of appalling. In each and every year since licensure began, the perinatal death rate for planned homebirth with a licensed midwife exceed the death rate for the ENTIRE state, including premature babies and high risk pregnancies. Even worse, the number has risen each and every year.

In 2009 Colorado licensed midwives provided care for 799 women. Nine (9) babies died for a homebirth death rate of 11.3/1000! That is nearly DOUBLE the perinatal death rate of 6.3/1000 for the entire state (including all pregnancy complications and premature births).

The data is conveniently broken down by type of death and place of death. For example, there were three intrapartum deaths for an intrapartum death rate of 3.8/1000, more than TEN TIMES HIGHER than the intrapartum death rate commonly experienced in hospitals. There were 4 neonatal deaths for a neonatal death rate of 5/1000. That's TEN TIMES HIGHER than the national neonatal mortality rate for low risk hospital birth with a CNM. On hundred women were transferred in labor or after delivery for a transfer rate of 12.5%. The neonatal death rate in the transfer group was 50/1000, an appalling neonatal death rate ONE HUNDRED TIMES HIGHER than that expected in a group of low risk women.

I honestly do not understand how someone like you, who seems to be nice person, can actively ignore the fact that Colorado midwives are letting babies die in large numbers. How can homebirth advocates consider that acceptable? Why isn't a midwifery organization investigating the extraordinary death rate? Do homebirth advocates care about babies, Jill, or do they only care about homebirth?

May 23, 2011 | Unregistered CommenterAmy Tuteur, MD

Kristen please do post here if you find out more about how much (if any) of a rise there was in homebirth among women of color. The article said "For all races combined, about 1 in 143 births were at home in 2008, up from 1 in 179 in 2004." which doesn't tell us enough.

Michelle, thanks for pointing out the economic component re: Medicaid (and insurance for that matter) not reimbursing for midwives. Though in the reporter's defense, he or she might not have had any information handy about whether cost was driving the racial imbalance and didn't want to speculate.

May 23, 2011 | Unregistered Commenteremjaybee

Emjaybee: I am on the phone right now, so cross-posting is cumbersome, but the article I linked to earlier today broke it down.

Amy: At least read enough to learn to whom you should properly address your comments/questions, please. Which, btw, is not to imply that Emjaybee is not a nice person.

May 23, 2011 | Registered CommenterANaturalAdvocate

Emjaybee is free to answer why she thinks it is acceptable that Colorado midwives have an appalling death rate and that no one in the world of homebirth advocacy is doing a thing about it.

May 23, 2011 | Unregistered CommenterAmy Tuteur, MD

ANA thank you for reminding me of the NYTimes piece; it has a better breakdown on race

Link here: http://www.nytimes.com/2011/05/24/health/research/24childbirth.html?_r=1&hpw

Relevant part here:

"The turnabout was driven by an increase of 28 percent in home births among non-Hispanic white women, for whom one in 100 births occurred at home in 2008. That rate was three to six times higher than for any other race or ethnic group.

Home births declined slightly among non-Hispanic black women, to 0.28 percent in 2008 from 0.30 percent in 2004, while home births for Hispanic and American Indian women were unchanged, at 0.20 percent and 0.38 percent, respectively. Home births among Asian and Pacific Island women increased slightly, to 0.27 percent from 0.24 percent of all births.?

May 23, 2011 | Registered CommenterEmjaybee

the "race" issue is about a little more than money. sure ultimately, it may boil down to money and lots of black women on welfare and such BUT white women have had this history of deciding for women what is the "in" thing to do at the moment. white women wanted to be in the hospital because their white male counterpart told them it was good. they went along with it. to be in the hospital was good. to be home was looked down upon. black women wanted to be good and have good things and do good things, too. white is right, so they went into the hospital, too--not to mention the set up by obs and nurses and the gubment, whom i'm sure were white, to create public health departments and free health care, to help to convince black women to come into the hospital.

now, you have changed your minds. but you forgot to tell black women this. but i'm sure you're actively working on it, right?

May 23, 2011 | Unregistered Commenterreader
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