Clarifying issues on midwifery and home birthing

Posted Jan. 11, 2009, at 8:39 p.m.

As a practicing board certified obstetrician/gynecologist of 22 years, I feel that it is necessary to clarify a few issues brought forth in the recent support of midwifery home deliveries, “Support home birthing” (BDN letters, Jan. 1).

First and foremost we must clarify the distinction between a certified nurse midwife and a certified professional midwife. A certified nurse midwife is someone who has a nursing license and has had additional training in obstetrics and delivery. They work under the supervision of a physician whom they can call for support and assistance.

A certified professional midwife (a title recently granted to them through our state Legislature) is not necessarily trained in any field of medicine and does not practice under a supervising physician. They were formally referred to as “lay midwives.” The recent decision by our Legislature not to license these individuals was largely due to the fact that they could not demonstrate that they had the requisite degree of training and education to be considered experts in childbirth. Given that information, the Legislature felt that licensing these individuals may encourage unsafe and possibly dangerous home births.

The allegations that physicians are against home deliveries for financial reasons are entirely without merit. Last year lay midwives delivered approximately 1 percent of babies born in Maine. Should this small number be divided among all the obstetricians and family practice physicians doing deliveries, I doubt any of them would see a windfall in revenue.

While we don’t have a financial interest in this issue, we as physicians in Maine have an obligation to speak out on issues relating to public health. Furthermore, I like many physicians in our state, are hospital-employed. This means that my salary is set and not based on the number of deliveries I do. My one and only goal is to deliver a healthy baby to a healthy mother.

As to the rates of infection and reduced length of labor, I am not sure how these statistics are obtained since lay midwives are not required to report this data to the state and should they do so would only be voluntary and probably with bias. I agree that many deliveries may be accomplished at home safely but who are we to predict which delivery will be without complications? Any experienced labor and delivery nurse knows that the most unexpected event (hemorrhage, for example) can happen without warning and lead to devastating consequences for the mother and baby.

To those who “look forward to the day when Maine families are allowed to fully experience what science has shown to be true” that day has been here for many years. Women currently have the choice to deliver at home with a lay midwife and may do so without any intervention from the state or medical personnel. As a matter of fact I never have heard of a situation where a woman was extricated from her home and forced to go to a hospital to deliver.

I sincerely believe that every woman has the right to choose how and where she delivers, but this choice should made in an informed and educated manner. It is more important to me that the woman who chooses to have a delivery in a safe hospital environment be allowed to do so without the views of those who disagree being pushed upon her.

Shelby L. Wilbourn, M.D., of Belfast is a board certified obstetrician/gynecologist.

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