Dawn Finney is a certified professional midwife and owner of Birthroot Midwifery in Columbia.
“Why don’t you just have the baby in the hospital?”
This was the question my father posed to me when I told him, 19 years ago, that I was planning to have my second baby at home. I was on the telephone nervously sharing with my parents my plans, and essentially, my hopes for this birth to be different than my first, which had been medically managed and hadn’t gone as I had imagined.
Even so, I still appreciated the care I received from the certified nurse midwife who attended to me at the large university hospital in Iowa. I remember a moment, after the profundity of bringing my beautiful son into the world, in which I looked at my midwife and thought: “I need to do what she’s doing.”
My path to midwifery was different than hers, though. I did attend nursing school, for a short time thinking I would pursue a master’s degree in nurse-midwifery and work in a hospital as most CNMs do. However, I was fortunate to meet a wonderfully skilled midwife who apprenticed me for four years, including a midwifery internship program in St. Petersburg, Russia. I earned my Certified Professional Midwifery credential, joining the ranks of the only type of maternal health care provider with training specific to the out-of-hospital birth environment.
“But you can have your insurance pay for the birth in the hospital,” said my father. Ever practical, he voiced concern for the expense we would incur as a graduate-student family living on one income. Yet, this kind of maternity care offered quality and value that was worth paying out-of-pocket for: hour-long appointments with plenty of time to talk about my concerns and ask questions, care that respected my choices and treated me like an individual, privacy and comfort of being in my home instead of being at the mercy of policies and procedures decided by board rooms of lawyers, and postpartum care complete with breastfeeding support that came to my home when I needed it. The fee we paid our midwives was a fraction of the cost of a hospital birth for empowering care that felt priceless.
In Missouri, there have been yearly efforts to license the legal practice of CPMs in the hopes that this would allow insurance reimbursement for midwifery care and planned home birth. If accomplished, it could save millions of dollars as it has in other states with licensed midwifery.
“Call us when you go into labor so I know when to start worrying.” Now my mother was on the phone with me and I know that, in her own way, she was supporting my decision to birth at home. Worry. It’s a rare person who doesn’t feel some degree of this emotion when embarking on the journey to bring a baby into the world.
Indeed, “what if something goes wrong” is a question that must be addressed whenever a couple comes to the complimentary interview appointment at which I discuss the option of midwifery care and home birth. If the couple does not bring this up, I do.
The main risk of home birth is encountering a complication in which speedy access to a hospital is necessary. In reality, that kind of emergency is less common than our cultural fear about birth would have us believe.
The most frequent reason to transport to a hospital is the opposite problem: a prolonged labor that has stalled and needs augmentation. A strong component of midwifery training is learning to recognize and manage any complications of birth and transporting to hospital when necessary.
As I came to learn through my own birth experiences and my work as a midwife, a big driver of women choosing home birth is a less-than-satisfying birth experience in hospital with interventions that felt coerced or possibly unnecessary. Women having a first baby often choose home birth because they know they have a 33 percent chance of having a C-section just by giving birth in a hospital.
Ultimately, I explain that no labor and birth is totally risk-free, no matter where a woman gives birth. What couples need to sort out is which set of risks do they want to choose? The good news is that for both hospital and home birth, the vast majority of births result in successful outcomes for mothers and babies.
“Well, I guess that’s OK,” concluded my father. “I was born at home, too.”
It turns out that a traditional midwife welcomed him and some of his siblings into the world. My daughter was born, not too long after this conversation, in the comfort of my own home under the care of skilled midwives. It has been my great honor to continue the legacy of providing midwifery care for planned home birth that was once common for all of our families.