Kentucky may become the 34th state to license certified professional midwives after the State House of Representatives voted 96-1 on a bill to establish a state license.
Certified Professional Midwife is a credential developed by the North American Registry of Midwives. These midwives aren’t nurses or doctors but do have specific training, clinicals and must pass an exam in order to obtain licensure. They specialize in providing maternity care for women wanting to give birth at home and in birthing centers.
Currently 33 states recognize the licensure – most of Appalachia, including West Virginia, does not. The new Kentucky bill will recognize the licensure of about 20 CPMs that already serve Kentucky. Although the certification is recognized in neighboring states Indiana, Tennessee and Virginia, until the bill passes, practicing as a CPM in Kentucky is not legal.
Proponents for licensure argue that recognizing certification means that midwives have to maintain specific standards of care and that CPMs can help provide services to women living in rural areas without obstetric services.
Opponents argue that although most birth is “normal” birth, obstetric emergencies happen quickly and that CPMs are poorly equipped to handle worst case scenarios.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from Marshall Health and Charleston Area Medical Center.
Patricia Harman is the author of the bestselling novel The Midwife of Hope River. We last heard from her during our April, 2016 Inside Appalachia episode on home birth. Harman’s latest book – the Runaway Midwife – was released today. Kara Lofton talked with Harman about how more than three decades of work as a midwife informs her writing today.
On Being a Midwife
“One of the things about midwives is similar to a solider or someone in combat we’re right on the border between life and death and I think that makes for a great hero.”
On Writing About What You Know
“When you’re a writer they often say write what you know and the midwife in this new book, The Runaway Midwife, she could be any woman. She could be a broadcaster, she could be a teacher, she could be a counselor, any woman who has had it, who just can’t go on any longer and decides to run. But the fact that I am a midwife makes it easy to write stories about midwives and their experiences.”
On the Theme of Running Away
“I think women in particular, but probably all people in these modern times live with great stress. And often it’s things that we could maybe get out of, but sometimes its not. It’s family problems, its marriage, its work stress. And I think from time to time there will be for everyone you wish you could reinvent yourself you don’t want to kill yourself, you just don’t want to be here anymore and I think that’s why some people fantasize about running away.”
On Ending Her Books with Hope
“I remember one woman said ‘why does every strong female heroine in a book have to end up with a man?’ And I thought to myself ‘yeah! Why do I have these nice little endings to my books?’ And I think it’s because I really believe in hope. And after I thought about it I think that’s what unites all my books from my memoirs to my children’s book is the feeling that there is hope.”
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation, Charleston Area Medical Center and WVU Medicine.
Credit Kara Lofton / West Virginia Public Broadcasting
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West Virginia Public Broadcasting
A couple listens to Sarah (holding her newborn) talk about her home birth experience with Joanna Davis.
In a tiny basement living room in southwestern Virginia, two women and their husbands listen to Joanna Davis talk about what might go wrong during their births.
“So this is an Ambu bag, and if your baby was in trouble and needed help breathing this is what we would use,” she begins.
Davis is a home birth midwife based in southwestern Virginia, but serves a significant swath of central Appalachia. Several months ago, she held a birthing class for two families interested in using her services.
During the class, Davis and an apprentice went over every instrument and scenario – both good and bad – that could possibly occur during a birth. Davis says she requires all families to attend the classes so they know exactly what they are getting into.
Despite a nationwide increase in home births in the last few years, the percentage of women choosing this option remains less than 1 percent throughout most of Appalachia. But many who turn to home birth, like the two women in Davis’ living room, cite the desire to control their birthing experience and eliminate what they perceive as unnecessary medical interventions.
“Most of my philosophy of practice is that moms and dads do a great job of getting babies in there and they do a great job of getting babies out,” said Davis. “I really love when the dads catch the babies, when they are super in-tune and involved and all of that. I’ll step in when they need me to, but most of the time I feel like my job is to create a safe place where they can do their work.”
Credit Kara Lofton / West Virginia Public Broadcasting
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West Virginia Public Broadcasting
This is Sarah’s sixth baby and the first that was born at home. She said if she has a seventh she will not return to a hospital.
Davis worked for about ten years as what’s called a direct entry midwife – she didn’t have official training – but learned through careful studying, researching and shadowing other midwives. In January of 2015 she decided to pursue licensure and passed the necessary requirements to become a certified professional midwife – a designation recognized in Virginia, but not in Kentucky and West Virginia, although both Kentucky and West Virginia are currently working on legislation that would change that.
She said when she first started, the women she served were “super conservative on one end and super ultra liberal hippie, crunchy (‘those people’), and now we really are finding people that [are along that] whole spectrum [who] are much more interested in owning the experience of their own birth and wanting to be more comfortable and in control of their own births.”
Stereotypes May No Longer Fit for Families Choosing Home Birth
Credit Kara Lofton / West Virginia Public Broadcasting
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West Virginia Public Broadcasting
Cassandra Harvey holds her daughter at her Morgantown home.
At a pretty, upper-middle class Morgantown home, Cassandra Harvey’s baby is gurgling happily.
“My husband is a physician – he’s trained to deliver babies – but most OBs that work in a hospital setting, they’re actually surgeons, so they are trained to deal with things that come up that are not part of the normal birthing process,” she said.
Harvey has three children – the first was born in a birthing center, the second in a hospital, and the third at her Morgantown home. Harvey did later clarify that her husband is a general practitioner, not an obstetrician, and that his training in birth occurred as part of an obstetrics rotation in medical school.
Credit Kara Lofton / West Virginia Public Broadcasting
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West Virginia Public Broadcasting
Angel holds her daughter in Harvey’s Morgantown home. After a traumatic hospital birth with her second child, Angel choose to pursue home birth. Angel and Harvey’s daughters were born within six weeks of each other using the same home birth midwife.
“I will say that at first he was a little unsure about the whole home birth process, which is why we had a midwife even though he’s a doctor and could have handled it on his own,” she said. “But he said it was important to him that he get to just play the dad and not have to play the medical provider as well.”
Harvey was adamant that having a homebirth doesn’t mean she’s uneducated or reckless – two accusations she heard over the course of her pregnancy – but rather that she was hyper-educated – she knew exactly what she wanted, what the risks were and how to choose a provider who would help her achieve her goals.
“Most women, if they are low risk, can have a healthy delivery without any kind of intervention,” she said. “But in a hospital they are looking for those things. So when you have a intervention it can snowball and when I say on my terms I want it to be completely the way nature intended it to be without someone looking for a reason to create or have an intervention.”
This is not to say that all home births always go well or that everyone has a good experience with it. Almost all the mothers I talked to I met through the midwives who served them. So consequently, the population sample was enthusiastic about home birth.
Obstetricians Urge Caution
Doctor Dara Aliff is a Charleston-based OB/GYN. “I currently have in my practice two women who have documented PTSD from home births gone awry and are seeking care for that,” she said. “And so I think the idea that it can’t go wrong just because it’s in your house is completely false.”
Credit Kara Lofton / West Virginia Public Broadcasting
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West Virginia Public Broadcasting
Eva Gutierrez stands at the window of her home in Thomas, West Virginia. In this photo Gutierrez is just ten-weeks pregnant with her first child, but had decided to pursue home birth because it felt like a more holistic path.
While Aliff says she isn’t totally against home birth like some of her colleagues, she strongly cautions against what she calls “home birth at all costs,” and urges women to choose their providers carefully.
“I can’t think of a situation where I would say to someone, ‘Gosh you are just an ideal candidate to do that,’ because you never know who’s going to be the one, who’s going to be the one who all of a sudden isn’t. And that can happen quickly.”
The official viewpoint of the American College of Obstetrics is that “hospitals and birthing centers are the safest setting for birth.” However, the College “respects the right of a woman to make a medically informed decision about delivery.”
A little data to further muddy the waters. According to the Committee on Obstetric Practice, women who have planned hospital births are twice as likely to have a C-section as those who have chosen to give birth at home. However, planned home births are also associated with a two to threefold increased risk of neonatal death when compared with planned hospital birth.
Midwife Joanna Davis, whom we talked to at the beginning of this story, says she attends 12-24 births a year. This past year was her busiest year on record. Still, home births in the three states that she serves – West Virginia, Virginia and Kentucky – account for fewer than 1 percent of all births, according to the Centers for Disease Control and Prevention.
Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.
