Birth in a Hotel Room?

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.

Midwife Care versus Planned Parenthood

L of L

Two questions that are facing our nation and our state  could  be    connected. Should our tax dollars go to Planned Parenthood?  Will   Illinois certify Professional Midwives (CPMs) to provide home birth care? A number of states do recognize CPMs, but not all. In some states they can bill medicaid for home birth care.

In the United States we have three designations for midwives: Direct Entry who are apprentice trained;  Certified Professional Midwives who have taken courses, are apprentice trained and certified;         Certified Nurse Midwives who have completed a masters program in midwifery and almost exclusively practice in the hospital or in birth centers.   Hospital birth and home birth are different and require     different approaches to care. CPMs are skilled in attending home birth.

In the past I have written about my experience with home birth. After working in hospital labor delivery units for many years—beginning at Hutzel Hospital in Detroit in 1972—I made the surprising decision to sign on to a home birth practice (never thought I would do this). For four years I took weekend call as the birth nurse, attending women in labor, in their home.  A doctor or a CNM came for the  birth.  This    practice closed and attendants for home birth in Illinois are very few.

I attended 66 labors, 61 of which birth took place at home, 5 were transferred to the hospital. Through this experience my understanding of birth expanded. I was consistently attending women all the way through labor, birth and recovery.

Midwives and Birth
photo credit: T. Adriaenssen

All of the skills that I had taught as a Lamaze instructor were easier to include in the home setting. Women were more intuitive about working with their body. Interventions were fewer.

It was very important to carefully observe the progress of labor and recognize risk factors. An observant birth attendant could tell when transfer to the hospital was advisable. Unlike the hospital, where the use of medications, surgical rupture of membranes, a stationary position in bed and anesthesia pumps could set off a sudden emergency, problems became apparent gradually in the home. There was enough time to make a transfer to the hospital. Certification of  professional midwives at the state level could insure that midwives had the skills necessary for home birth.

What maternity care needs is a good communicating system between home birth attendants and hospital staff. Fear of a negative reception at the hospital sometimes leads to a delay in transfer to the hospital. Receiving a home birth patient in crisis can upset hospital staff– but on the other hand they are equipped to handle emergencies. The fear of lawsuits hovers over doctors.

But we should solve this. Midwives are focused on women’s health. They have more opportunities to teach and provide hands on care for women. Doctors are often balancing a very full schedule with minimal time with the patient,  I learned so much  about  the  women  I    attended by seeing them in their home setting. Midwives will bring the cost of maternity care down  and  improve the establishment of       successful breastfeeding.

Instead of putting tax dollars to work at Planned Parenthood,  let’s use the money to invest in health clinics  and  to increase  midwifery    services. CNMs that primarily work in the hospital could do a rotation in home birth, learning from CPMs. CPMs could do a rotation in the hospital with CNMs.  The legislature could work on tort reform  and   relieve doctors from the constant fear of lawsuits.

What can we do to move this forward?

  • Call or e-mail your Senators and House Rep., asking them to defund Planned Parenthood.
  • If you live in Illinois call or e-mail your House Rep. and ask him to support the House Bill, HB 4341.
  • You may also want to visit the website of Women Speak for Themselves. Not all women think that the government should provide funding for abortion.

Midwives and Birth

Linking with Tuesdays with a Twist,  A Little R & R and Whole Hearted Home