Home birth supporters seek to ease midwife rules in Maryland

More than 500 Maryland moms delivered babies at home last year, but as such births become more popular, a dispute is brewing over whether to make the process a more viable option in the state.

Home births are on the rise in the United States with deliveries jumping 29 percent between 2004 and 2009, according to data by the Centers for Disease Control and Prevention released last week. Maryland home births increased at an even more rapid clip of 62.5 percent.

But supporters of home births say that Maryland still places too many restrictions on obtaining a midwife, and they have started a grass roots movement to ease the standards. They are working with a Montgomery County delegate to introduce legislation that would open the door to more midwives delivering babies at home.

"The climate in this state toward home births is unfriendly and it made us want to try and do something about it," said Jeremy Galvan, a Hagerstown dad and paramedic whose son was delivered at home. Galvan recently helped found the group Maryland Families For Safe Birth to help make it easier for families to have home births.

State health officials, citing safety concerns, oppose loosening the restrictions. They issued a joint statement late last year reaffirming their view — and state law — that certified nurses or doctors must be present during home births. Heightening concerns in the medical and health community is the high-profile case of Karen Carr, a Maryland midwife who was convicted of two felonies last year after the death of baby boy she was delivering in an Alexandria, Va., home.

The joint statement was issued by the Maryland Department of Health and Mental Hygiene, the state's nursing board, the association that represents county health officials, and the Maryland affiliate of the American College of Nurse-Midwives.

"At this point it is a safety issue," said Fran Phillips, DHMH deputy secretary for public health. "It makes a world of difference if you have someone who has the right skills, right equipment and has a link to the hospital if something goes wrong."Heather Brown, 35, of Pikesville, delivered two of her babies at home, including a daughter born seven weeks ago. She said state officials need to be more open-minded about home births.

"It should be a valid choice for women who want to do it," she said. "It should be a woman's choice and not the doctor's and the medical establishment. It's not fair for the government to make it so difficult."

Home births are not new in the United States. In the early 1900s, until the creation of the modern day hospital, homes were the primary place where babies were born.

Today, such births are rare, making up less than 1 percent of all births nationwide and in Maryland. But they have re-emerged somewhat in the past decade as some women seek a more personal birth experience, without all the machines and tubes of a hospital setting. The CDC data showed that white women over age 35 who already have several other children are leading the trend in increased home births.

The issue of home births often pits the medical community and midwives against one another. Doctors and health officials often argue that people who deliver babies need an extensive medical background in case complications arise. Midwives, meanwhile, defend their qualifications and say there are no studies that show home births are any less safe than those in hospitals.

Under Maryland law, only a midwife with a certified nursing license can deliver babies in a home setting and they must collaborate with an obstetrician gynecologist. The majority of home births around the country, 43 percent, are performed by other types of midwives, including certified professional midwives, who Maryland does not allow to deliver babies at home. Certified professional nurse midwives have training in childbirth like other midwives, but specialize in out-of-hospital settings and must get a certification.

Parents say strict standards in Maryland are limiting home birth options and leading to unsanctioned home births, performed by midwives that mothers and other states say are qualified, but that Maryland refuses to license.

State officials issued the joint statement partly because birth certificate data from local health departments showed that more women may be using unlicensed midwives. An increasing number of parents who ask for birth certificates are telling health officials that no one assisted them in their home birth. That is sometimes a sign parents are trying to protect midwives without licenses.

Even nurse midwives — who can legally deliver babies in homes — say there are problems in Maryland.

Bayla Berkowitz works as a nurse midwife at CNM & Associates at Mercy Hospital in Baltimore. She said the practice associates with a hospital in part because it is difficult to do home births in Maryland. The practice tries to instead recreate the home setting in hospital rooms at Mercy.

"For legal reasons it's easier to [associate with a hospital] in Maryland," she said.

Mairi Breen Rothman, a nurse midwife based in Takoma Park, said it is hard to find a doctor to collaborate with. For years she practiced only in Washington, D.C. Doctors would work with her in Maryland because they feared liability issues, she said.

She said home births come with a negative perception of being unsafe. But Rothman said she comes prepared with oxygen and resuscitation equipment in case something goes wrong. Most problems can be caught early enough to send a women to the hospital if needed. And the majority of her births never have complications, she said.

"People think we go to people's houses and sprinkle herbs on them and hope for the best," Rothman said. "That is far from what we do."

Doctors don't dispute that working with a midwife in homes gives them pause.

"Most doctors don't want to do it because of the liability exposure," said Mark Seigel, an OB-GYN who practices in Rockville and Germantown.

Parents say finding a nurse midwife can be hard because there aren't many in the state. The few that exist are often booked ahead for months. So some people who don't want to deliver in a hospital turn to midwives who aren't supposed to do home births in Maryland.

Christy Larkin was one of them. Larkin said she was not satisfied with her experience after delivering her first two children in hospitals, including one in an emergency Cesarian section.

"The C-section was terrifying," she said. "You're strapped to a table like you're being crucified. You don't get to see your child come out. You don't get to hold him or touch him right away. It was not a pleasant experience."

Her most recent child was born eight months ago in her Harford County home. There was a doula — a person who offered emotional support — a midwife, her husband and four-year-old son. She liked being able to hold her child right after delivery.

She said that women are having home births despite the state's restrictions.

"There are women who are going to choose home births," Larkin said. "Do we want them birthing by themselves with nobody attending to them because Maryland isn't going to license certified professional midwives?"

Maya Brennan also was unhappy with her experience delivering her first child in a hospital two years ago. She felt the stress of the hospital environment worsened issues she was having with high blood pressure. She ended up having a C-section because doctors didn't think her body could handle the stress of pregnancy any longer.

Her second baby was delivered at her Baltimore home on a futon last year. Brennan said the pregnancy was in a calmer environment. Her blood pressure was high initially but then stabilized. Her daughter had a large head but the midwives were able to deliver without an episiotomy by having Brennan change positions during delivery.

"It was a perfectly healthy and good delivery and I would definitely do it again," Brennan said.

Maryland Families for Safe Birth is trying to get legislation passed during this year's General Assembly session to allow certified professional midwives to deliver babies at home. The group is working with Del. Ariana Kelly, a Montgomery County Democrat, who has drafted legislation she hopes to introduce soon.

"I think it is really important that we realize home births are happening and we make sure they are happening safely," Kelly said. "One of the best ways to do this is to license the practitioner so we can monitor the practice."

Medchi, the professional group that represents the state's doctors, said it probably wouldn't support such legislation.

"That doesn't seem appropriate," said Gene Ransom, Medchi executive director. "I think we should not be allowing people who are not trained to do this type of stuff. It is simply not safe."

Patricia A. Noble, executive director of the Maryland Board of Nursing, said she can't speak on pending legislation. But she said the current law helps protect babies and mothers.

State health officials also say they are not against home births, but they believe someone with a medical background should be present.

Supporters of home births say the state seems to be cracking down even harder on home births.

They point to a popular Catonsville nurse midwife, Evelyn Muhlhan, who recently had her license suspended by the Board of Nursing for not having a collaborative physician and delivering in homes without approval.

Some babies and mothers ended up in the hospital for complications, according to board of nursing documents. Muhlhan's supporters say it was the hospitals that complained and not the families, and that she did the right thing by sending the women to the hospital because of complications.

Muhlhan could not be reached for comment.

Source: By Andrea K. Walker, The Baltimore Sun