Why would a woman decide to give birth in a hotel? Yesterday WGN News reported 0n a birth that took place in a hotel. The midwife called 911 because the mother needed additional treatment after the baby was born (the baby was healthy). The police were wondering why and how this could happen.
I have some thoughts about this. After working in hospital labor/delivery units for many years, I took weekend call for a home birth practice staffed by doctors and midwives. I learned about different approaches to birth care.
In the hospital I worked within the medical model of birth care. When I assisted the home birth practice, we worked with a physiological model of birth care. Certified nurse midwives or CNMs are trained in the medical model. Certified professional midwives or CPMs are trained to support physiological birth.
In the medical model of birth the doctor or midwife manages the birth process, sometimes aggressively. It includes electronic fetal monitoring, induced or stimulated labor, artificial rupture of membranes, pain control with narcotics and/or epidural anesthesia. All of these interventions have some risk and may lead to more interventions.
The physiological model of birth allows labor to progress without intervention. The baby’s heart rate is monitored intermittently by doppler. The mother’s blood pressure and temperature is monitored. The birth attendant makes sure that the laboring woman stays hydrated with water, juice, tea or broth.
In the home setting I learned that pain was a signal that helped to direct both the mother and attendant. Simple measures to relieve pain were employed—compresses, massage, change of position, a warm shower, a birth tub. The type of pain could be a sign of the baby’s position or the stage of labor and helped with decisions.
In Illinois certified nurse midwives can attend home births if they have a doctor backing up their practice. But CNMs mainly practice in the hospital and CPMs are illegal in Illinois. It is difficult for a woman to find a midwife for home birth. Perhaps the hotel was a meeting place for midwife and client that lived a distance from each other.
Illinois does not license certified professional midwives, although neighboring states do. CPMs receive their certification through classes and apprentice training (different from nursing school).
Some women prefer to deliver in a home setting instead of the hospital—they prefer to avoid or limit interventions. The prefer the privacy and quiet of home. They want to respond to cues from their body with support and guidance. When I worked in home birth, many of the women had previously delivered in the hospital. Some had been traumatized by the experience.
For years the midwives in Illinois have lobbied for regulation and licensure for CPMs. Licensure would set standards for CPMs. It would insure that the midwife was qualified to attend births and set guidelines for hospital transfer.
Pediatricians in Illinois are against home birth. My observation was that infants had less blood sugar and temperature problems at home than what I saw in the hospital. In the home infants were placed immediately skin to skin with mother. The immediate contact with mother assisted the establishment of breastfeeding.
Hospital or home–each place has advantages and disadvantages. Some women prefer to give birth in the hospital. Others prefer to give birth at home with a midwife. I think women should have a choice.
This post is part of #Write28Days. To view the other posts in this series click here.
