A nonprofit publication of the Kentucky Center for Public Service Journalism

Gena Bigler: Choosing a home birth may
be difficult but also may be best choice

In 27 states, Certified Professional Midwives (CPM) practice legally and some are reimbursed by Medicaid. In Kentucky, Certified Professional Midwives are not recognized and can face prosecution for assisting a birthing mother.  It is perfectly legal for a woman to give birth at home, but an attendant risks possible jail time for helping. The Kentucky Senate is currently considering a bill to recognize Certified Professional Midwives.

I never thought I would have a home birth. I expected, at the advice of a doctor who noted my narrow hips, to have a scheduled cesarean. After fully researching my options, interviewing multiple care providers and researching maternal and infant outcomes I decided to have my baby at home. Many Americans are making the same choice. According to the Centers for Disease Control, from 2004 to 2009 home births increased 29 percent. The CDC also notes that home births have a lower risk profile and that the cost is about one-third that of a hospital birth.

There are a lot of reasons women choose to give birth at home. Some are guided by their religious beliefs, some are avoiding the increasing number of medical interventions customary in a hospital birth, and some just feel more comfortable at home. It is not a decision any woman makes lightly. If you ask any woman of any age about the birth of her children, she will likely be able to tell you her birth story in detail, even if it happened decades ago. Women, babies and families benefit from having well-trained care providers wherever they give birth.

There are multiple studies that support the safety of healthy low-risk women giving birth at home. Marsden Wagner, a perinatologist and epidemiologist and former director of Women’s and Children’s Health at the World Health Organization, has been a vocal advocate for both midwifery care and homebirth. As a proponent of evidence-based medicine, Wagner has authored several books on the subject of birth. Our southern neighbor, Tennessee, not only certifies CPMs, but is home to world renowned CPM author and lecturer Ina May Gaskin.

Beyond the health benefits of midwifery care, the cost benefits are significant. Midwives typically have fewer interventions, which decreases the cost per birth. Washington state has included midwives in its strategic plan for Medicaid. Jeff Thompson, M.D., MPH, chief medical officer of the state of Washington’s Medicaid program referenced the savings and said he hoped to double the number of births attended by CPMs over the next few years.

In many developed nations, midwifery care is the norm. Only in North America do we regularly have specialized surgeons attend to healthy low-risk mothers.   You might expect that we would have much better outcomes with such highly trained birth attendant, but you would be wrong. Our infant mortality rates are shocking. The United States has infant deaths at more than double the rate of Sweden and Japan. We can do better.

It wasn’t that long ago that it was the norm for women were strapped down and sent to the “twilight sleep” while babies were forcibly removed with forceps. When we look back now, it is startling to think that was the norm or that fathers weren’t allowed on the maternity floor or that babies were held in nurseries far from their mothers. By following the evidence, birth has improved. By following the evidence, it will continue to improve.

The Certified Professional Midwife who cared for me was highly skilled and had trained and attended births in states that recognize CPMs. Her knowledge of and experience with natural birth was extensive. She was very clear about what would merit transport to a hospital. There were no strangers, no beeping machines, no hospital smell, no unwanted drugs and no monitors or cords tethering me to a bed. Choosing to have a home birth was a difficult decision, but it was the right choice for my family.

Gena Bigler is passionate about public service and credits her time serving nonprofits in AmeriCorps and Volunteers in Service to America (V.I.S.T.A.) with teaching her extreme budgeting and bargain shopping. Gena is now CFO of McNay Settlement Group and serves on the board of the Lactation Improvement Network of Kentucky (L.I.N.K.). Gena would be happy to hear from you at lgbigler@gmail.com.


Click here to read more columns from Gena Bigler.

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