The rugged Appalachian mountains can create some interesting birthing situations and it’s been that way for a long time. It used to be that women typically gave birth in home-like environments. Today most women head to the hospital and the Centers for Disease Control and Prevention reports that across the U.S., one in every three mothers has a cesarean delivery.
More and more women seem to want to reclaim this ancient rite of passage as their own by having their babies at home. A recent study in Oregon found that home births are riskier than having a baby at a hospital. The study was published The New England Journal of Medicine
In this week’s show, we’ll hear from a midwife who started delivering babies in the early 1970's. We find out what it’s like to deliver a baby at home. And we speak with one doctor about why she opposes home birth. We also visit a famous hippie commune in Appalachia that's said to be the birthplace of modern midwifery.
Home birth rates are particularly low in Appalachia. West Virginia has one of the lowest numbers of home birth rates in the country. Nationwide about 1 percent of births happen at home, according to the CDC.
But a growing number of women are turning away from hospital births, citing reasons like the desire to “control their birth experience,” avoid a cesarean, and find a provider who respects their wishes. Over the past four months, health reporter Kara Lofton visited some of the families choosing home birth in this region and talked to the midwives who serve them in Kentucky, Ohio, Virginia and West Virginia. In this detailed report she looks at both the controversy around home births and why some women are choosing this option despite legal obstacles.
A new law in West Virginia that passed in March is expected to increase healthcare to parts of the rural parts of the state. Kara Lofton explains that the new law will allow experienced nurse midwives to practice independently from hospitals.
Nurse midwives are the not the most common type of midwife in the U.S., but the vast majority, more than 94 percent, practice in hospitals.
What is a midwife?
Well, it’s complicated to explain. There are lots of different kinds, according to the American Pregnancy Association.
• Certified Nurse-Midwife (CNM): a midwife trained and licensed in nursing and midwifery. Nurse-midwives must have at least a bachelor’s degree from an accredited institution. They are also certified by the American College of Nurse Midwives.
• Certified Midwife (CM): an individual trained and certified in midwifery. Certified midwives must have at least a bachelor’s degree from an accredited institution. They are also certified by the American College of Nurse Midwives.
• Certified Professional Midwife (CPM): an individual who is trained in midwifery and meets standards of the North American Registry of Midwives. Multiple educational backgrounds are recognized to become a CPM.
• Direct-Entry Midwife (DEM): an independent individual trained in midwifery through various sources that may include apprenticeship, self-study, a midwifery school, or a college/university program.
• Lay Midwife: an individual who is not certified or licensed as a midwife but has received informal training through self-study or apprenticeship.
Appalachian Midwives during the 1930s
Patricia Harman is an author and a retired certified nurse midwife who has written some compelling historical fiction about what it was like to be a midwife in Appalachia in the 1930s. She recently spoke with Harman about her book to get an idea of the history of midwifery in Appalachia.
Here’s an excerpt from her book The Midwife of Hope River. The scene takes place in a coal camp in West Virginia during the Great Depression. Our colleague at West Virginia Public Broadcasting, Glynis Board, is reading this passage from Harman’s novel.
Since the 1970s, The Farm Midwives Have Helped Deliver 2,690 Babies
In home-birthing circles there’s a famous midwife named Ina May Gaskin who is revered for pioneering natural child birthing practices in this country. She wrote a book now known around the globe called Spiritual Midwifery. Mostly, it’s a compilation of natural childbirth stories that happened right here in Appalachia at this earth-crunchy, baby-birthing place founded by Ina May in Tennessee in the early 70s called The Farm Midwifery Center.
The Birthplace of Modern Midwifery: Summertown, Tennessee
Forty-five years, a dozen books, and more than 2,690 babies later, The Farm is still going strong. And we happen to know one young woman who knows the place intimately, and she happens to be our producer, Roxy Todd.
Roxy lived at The Farm as a very young baby and recently revisited the place to bring us this very special story.
Weighing Mothers' Options
According to the CDC across the nation the number of women giving birth to babies at home or at a birthing center increased nearly 30 percent between 2004 and 2009.
Researchers in Oregon did find that home births are riskier than having a baby at a hospital. Aside from the mother, probably one of the most important roles for home-births is a midwife.
While midwifery in rugged rural like places in Appalachia was once a necessity, more mothers seem to be looking to home births as a way to find comfort and courage in the birth of their children but there are risks.
The bottom line is that it’s a decision that the mother, the woman, has to make. That decision should be respected.
Call the Midwife
You may already be familiar with midwifery from a PBS show called, Call the Midwife. It airs on PBS stations across the country and has done a lot to bring awareness on the subject.
Now in its fifth season on West Virginia Public Broadcasting, the series is based on the best-selling memoirs of the late Jennifer Worth. It tells colorful stories of midwifery and families in London's East End in the 1950s. Jenny Lee, a young woman raised in the wealthy English countryside, has chosen to become a nurse and now, as a newly qualified midwife, has gone to work in the poorest area of the city. Attached to an order of nursing nuns at Nonnatus House, Jenny is part of a team of women who minister to expectant mothers, many of whom give birth at home in appalling conditions. The drama follows Jenny as she meets her patients and learns to love the people who live in the East End.
Here is episode 8 from Season 5:
Call the Midwife can be seen Sundays at 8pm on West Virginia Public Broadcasting. Current episodes are also available on West Virginia Public Broadcasting's App.
Music in today’s show was provided by Michael Howard, David Mumford, Anna and Elizabeth, Little Sparrow, Andrea Tomasi and Tom Briding.
Our producer is Roxy Todd. This week's show was edited by Glynis Board and Suzanne Higgins. Our audio mixer is Zander Aloi.