Nicole Schwartz, MSW, DEM
For low risk mothers, (meaning those without any major health issues such as unmanaged diabetes or uncontrollable hypertension) research shows that the safest place to give birth to their baby is at home with the support and care of a trained birth attendant. Without the restrictions, standards of practice, and routine medical interventions that are commonplace in hospitals, women and babies are not exposed to increased risk and overall experience healthier births with fewer complications, infections and surgical deliveries.
Homebirth providers are experts in low-risk, physiological birth and are prepared and capable of managing the most common obstetrical emergencies in out-of-hospital environments (postpartum hemorrhage, shoulder dystocia and neonatal resuscitation are the three most common). The countries with the lowest infant and maternal mortality rates utilize homebirth with midwives as the standard of care, using the hospital only if the need arises.
It is important to know that when choosing a homebirth, families are not outside of the medical system. If a complication arises during any part of their pregnancy, labor or immediate postpartum period, they are able to consult with or receive the care and support of an obstetrician or emergency medical provider. While most midwives attending homebirths in Pennsylvania do not have admitting or practice privileges at local hospitals, most have relationships with physicians in their community.
There are three types of providers that serve families choosing to birth at home in Pennsylvania.
• Certified Professional Midwife (CPM)
A Certified Professional Midwife is a knowledgeable, skilled and professional independent midwifery practitioner who has met the standards for certification set by the North American Registry of Midwives (NARM) and is qualified to provide the midwifery model of care. The CPM is the only international credential that requires knowledge about and experience in out-of-hospital settings. Currently, the Commonwealth of Pennsylvania does not offer licensing or prescriptive authority for CPM’s.
• Direct-Entry Midwife (DEM)
A direct-entry midwife is an independent practitioner educated in the discipline of midwifery through self-study, apprenticeship, a midwifery school, or a college- or university-based program distinct from the discipline of nursing. A direct-entry midwife is trained to provide the Midwives Model of Care to healthy women and newborns throughout the childbearing cycle primarily in out-of-hospital settings. Currently, the Commonwealth of Pennsylvania does not offer licensing or prescriptive authority for DEM’s.
• Certified Nurse Midwife (CNM)
A Certified Nurse-Midwife is an individual educated in the two disciplines of nursing and midwifery, who possesses evidence of certification according to the requirements of the American College of Nurse-Midwives. In Pennsylvania, CNM (Certified Nurse Midwives) can attend births in hospitals, birthing centers, and, with a written practice agreement with an current, practicing obstetrician, homebirths. The Commonwealth of Pennsylvania requires licensing for CNM’s and the Department of Health is working to establish prescriptive authority for CNM’s.
The type of provider chosen should meet a family’s individual needs and should be someone they feel confident in and comfortable with. It is imperative to investigate a potential care providers training and education, their birthing philosophy, as well as their general practice protocols.
While the choice to birth at home is not one that is right for every family, overall, families report having a more positive experience when they participate in care that accounts for their individual health history, participates in shared decision making and has shared values about birth. For some families, that is the care of an obstetrician, for others it may be the care of a midwife. What is most important is that families recognize that they have options. Hospitals, birthing suites, freestanding birth centers and home are considerations when choosing where to birth their baby.
For more information:
Midwives Alliance of Pennsylvania (http://www.pamidwivesalliance.org)
National Association of Certified Professional Midwives
North American Registry of Midwives
Midwives Alliance of North America
Citizens for Midwifery
Choices in Childbirth
American College of Nurse-Midwives
Nicole Schwartz, MSW, DEM began her journey as serving members of the community as a trauma specialist. With a passion for anthroposophic and holistic health and wellness, she began a journey from therapist to midwife, serving women during the childbearing year. As a traditionally trained midwife, Nicole provides holistic, compassionate, and individual care to low risk mothers and their partners seeking to birth their babies in an out-of-hospital environment. She believes that peace on earth beings with birth and works tirelessly toward a future where mothers, partners, and babies find their own power during the healthy, natural, undisturbed birthing process. To learn more about her practice, visit: www.SudharmaBirth.com or find Sudharma Birth Services on Facebook.