Women haven’t always given birth in hospitals. In fact, it wasn’t all that long ago that babies were delivered at home with the help of a midwife. The practice of midwifery never really went away, but blended into the background with the rise of hospitals. What midwifery looks like now varies from state to state and it’s a source of contention in the North Carolina General Assembly.
Here's a look at what it’s like to navigate midwifery in the modern world.
Julie McLemore is about 33 weeks along with her fifth baby. She's 32 years-old and affectionately calls this soon-to-be new addition "the tiebreaker." She already has two girls and two boys.
On this day, she has a prenatal checkup, but she’s not going anywhere for her appointment. Julie's midwife, Damaris Pittman, drove an hour to South Carolina to see Julie in her own home. Damaris checks her blood pressure, listens to the baby’s heartbeat, and she has a lot of questions about nutrition, hydration, and exercise for Julie.
Julie says she didn’t experience this amount of one-on-one attention when she gave birth in a hospital. That's part of the reason she wanted to try a home birth with a midwife.
"With the hospital births I’ve had, just the regular appointments, I've never been asked any of those questions. It’s nice to have somebody who cares and is with you all along the way rather than just doing the basic," says Julie.
Damaris had midwives attend both of her births and feels that midwifery was something she was called to do. She’s a Certified Professional Midwife licensed in South Carolina and has about 25 years- worth of experience. That means she can legally attend a home birth, like Julie’s, under South Carolina law. But North Carolina where Damaris lives, is a completely different story.
Midwives in North Carolina are Certified Nurse Midwives who have physician supervision. That doesn’t mean the physician is present for the birth, but is available to consult or collaborate with. If a Certified Nurse Midwife wanted to attend a home birth in North Carolina, she would need special physician approval. That’s a tall order to fill, which is why Damaris makes her commute across state lines.
"I would love for it to be legal in North Carolina. I’ve always wanted to practice in my home state. It would be much easier for me. I do a lot of driving," says Damaris.
In 2009, Damaris opened a birthing center in Fort Mill along with several other midwives. Damaris co-owned the center until 2015 when they decided to close after an infant died. Damaris was not involved in that case. During that time, the center got a lot of bad press. But it should also be noted, if you go to Carolina Community Maternity Center’s Facebook page, people have a lot of positive things to say. Many mothers Damaris worked with when the center was open sought her out after it closed. They wanted to have a home birth and they wanted her as their midwife.
That’s the case for 35 year-old Amber Canaan. Damaris checks in with Amber during this postpartum visit. Her baby is about 6-weeks-old. Amber’s had all of her babies outside of the hospital. She wanted to avoid what she calls "unnecessary intervention" she saw when she worked in a hospital as a nurse.
"I guess, people think that bad things don’t go on in a hospital, that if you're in a hospital, you're guaranteed safety. But I've seen as a nurse, that’s not true," says Amber.
It’s that issue of safety that’s at the core of this midwifery debate. Home births remain less accessible to women in North Carolina. There is current legislation that would greatly affect how Certified Nurse Midwives work in North Carolina, although it doesn’t involve home birth policies. House Bill 88 would eliminate the requirement for Certified Nurse Midwives to have physician supervision. One of the bill’s sponsors, Representative Gale Adcock who is also a nurse practitioner, says this would help Certified Nurse Midwives reach more rural areas. She calls the current physician supervision “old fashioned.”
"There are a large number of counties in our state that have no obstetrical providers at all. Part of this is because right now a midwife can’t go into an underserved county and work, unless a supervising physician is willing to sign an agreement that says they can do that," says Adcock.
There are at least 31 North Carolina counties without any obstetrical provider. The American Congress of Obstetricians and Gynecologists estimates the U.S. will have 6,000 to 8,800 fewer OB-GYNs than needed by 2020, under the current parameters of the country’s health care system.
Not everyone is on board with House Bill 88. The North Carolina Medical Society opposes the bill, saying physician supervision is a key part of how Advanced Practice Registered Nurses work in the state, which includes Certified Nurse Midwifes. "The entire health care system values a team approach to care-delivery. This proposal seems to go in exactly the opposite direction,” the society said in a statement.
House Bill 88 is currently in committee.
Last month Alabama made significant changes to its midwifery policy. Alabama Governor Kay Ivey signed a bill into law that will allow midwifes to attend homebirths. They would need to be Certified Professional Midwives who must have a license from the state to practice, similar to South Carolina policy.
What it comes down to, says Damaris Pittman, is that women will always want choices when it comes to their health care and birthing options.
"No matter what, midwives can’t be done away with," says Damaris.
As long as women want the option of a homebirth and Damaris can attend them legally in South Carolina, she’ll keep making her long drive. And maybe one day if legislation changes in her home state, her commute will get shorter.
