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Considering Another Delivery Option

Pregnant women in North Carolina could have home birthing options sanctioned by the state by the end of the year, if a recently formed committee approves of licensing certified professional midwives (CPMs) to attend home births.

"The House Select Committee on Licensing Midwives was created by the Speaker of the House of Representatives, Joe Hockney, to study the needs of North Carolinians who choose to give birth at home and to consider allowing the licensing of Certified Professional Midwives," explained Karen Cochrane-Brown, an attorney for the committee and a staff attorney for the North Carolina General Assembly.

More than 100 women attended the first meeting in February to rally support for home births, according to committee member Caron Jones, MSN, FNP, CNM, chair of the North Carolina chapter of the American College of Nurse-Midwives (ACNM).

The subcommittee is charged with bringing a recommendation to the North Carolina legislature by December 2008, Jones said. Committee meetings are open to the public; however, not all meetings allow for public comment. Meetings are held at the North Carolina General Assembly House of Representatives Legislative Building in Raleigh.

Resistance Exists

The licensure issue hasn't drawn support from everyone, however. Many medical doctors don't support home births attended by a certified professional midwife, Jones noted, because CPMs don't have physician backup in case of complications.

Much of the resistance by the medical community is due to insurance issues and the threat of litigation, Jones said.

About 230 home births occurred in North Carolina with CPMs during 2006-07, Jones noted. "The outcomes [of these births] are well-researched and the data supports that home births with a CPM are safe," Jones said.

Ginny Williams, RN, a retired Beaufort County nurse, has been appointed to the committee. Williams was a maternity nurse and is the vice chair of the Beaufort County Board of Health. Becky Bagley, MSN, RN, CNM, is interim director of the nurse-midwifery education program at the East Carolina University College of Nursing in Greenville, NC. Bagley also is on the committee to consider licensing of certified professional midwives.

Bagley said the request to begin the licensing of CPMs came from the North Carolina Friends of Midwives, a grassroots organization dedicated to promoting, supporting and protecting midwifery in the state.

"I see both sides of this emotional issue, but I also see the need to form a [legislative] position so CPMs can be regulated," Bagley said.

Types of Midwives

The existing hierarchy of practicing midwives is confusing, Bagley admitted. She added education and credentials are key elements of the decision regarding licensing eligibility.

The three types of midwives are CPMs, certified nurse-midwives (CNMs) and direct-entry midwives.

"Certified professional midwives do not have to be nurses, but they do have to receive training, take examinations and participate in a practical portion of their studies to perform through accredited, legitimate organizations," Bagley said.

CPMs take an exam administered by North American Registry of Midwives.

CNMs like Bagley and Jones are registered nurses with advanced training. In North Carolina, nurse-midwives are licensed as nurses and approved to practice as CNMs. It is not a separate license. Nurses apply for midwife status through the state board of nursing, and approval is granted by the Midwifery Joint Committee, which includes CNMs, MDs specializing in obstetrics, and representatives from both the Board of Nursing and Board of Medicine. CNMs in North Carolina are required to practice in collaboration with a physician who also does obstetrics.

The American College of Obstetrics and Gynecologists (ACOG) does not support care by midwives who are not certified by the American College of Nurse-Midwives, or the American Midwifery Certification Board, according to the ACOG Web site.

Why Home Birth?

As a certified nurse-midwife, Bagley's experience is confined to hospital birthing facilities, and she added she has no desire to attend home births. Instead, she would like to see hospital births made as homelike as possible.

Bagley said she could understand why some women choose to give birth at home. "It's a completely different environment, where the woman is in more control and not 'hurried' through her labor," Bagley said.

Even in ideal situations, life-threatening emergencies could occur in moments. According to Jones, many North Carolinians want childbirth options for a variety of reasons. "Religious issues, fear of hospitals, financial issues, insurance issues, a desire for less medical intervention as well as personal or cultural reasons all influence a woman's decision with respect to where she gives birth to her baby," Jones said.

Another reason a woman may choose a home birth is cost. "For those facing the cost of delivering their child without insurance, a home birth becomes very attractive," Bagley said.

Some medical conditions that should be red flags to home practitioners include gestational diabetes, preeclampsia, breech presentations, twins or other multiple births, and vaginal deliveries after a previous c-section, Bagley said. "An emergency transport plan needs to be in existence for all home births," she said.

  • For more information: American College of Nurse-Midwives North Carolina Chapter (; North Carolina Friends of Midwives (

    Melinda Rizzo is a freelance writer for ADVANCE.

    By the Numbers

    127,646 - Number of babies born in North Carolina in 2006

    12,730 - Number of births attended by certified nurse-midwives in home, hospital or birthing center settings

    704 - Approximate number of births overseen by other attendants

    Source: North Carolina State Center for Health Statistics

  • Articles Archives

    Eleven weeks ago I gave birth to my fourth child... at home. My 10 lbs., 21 inches, 16-days-late baby girl was born safely into the hands of my Certified Professional Midwife (CPM). I was also attended by a midwife apprentice, and lovingly supported and encouraged by my husband and my three other young children. This was my second homebirth, and I have also had two hospital births. As an educated woman with the financial means to determine the birth of my choice, I chose homebirth with a CPM as the safest and most natural option. My care team was skilled, knowledgeable, supportive, and competent. The state of NC must seriously consider the licensing of CPM's as the next logical step in providing quality maternity care for all eligible women. A woman experiencing a low-risk pregnancy and labor is served better by a caring, consistent CPM, who can attend her in the security and comfort of her home, rather than receive the care of an obstetrician who is trained in the care of high risk pregnancies. Further, many women do not have maternity benefits, and the cost of an OB and a hospital birth can be quite costly. Birthing women in other countries are routinely cared for by midwives, many in their own homes, with excellent outcomes. Let us move forward to give NC women and all women the freedom of choice that is their right in this country.

    Janice HernandezMarch 27, 2008
    Wilmington, NC

    Thank you for this important article featuring an issue that faces not only the citizens of North Carolina, but families in other states where licensing of Certified Professional Midwives (CPMs) is currently denied. We look forward to the day when women's freedom to birth with the attendant of their choice isn't denied in North Carolina.

    I believe that the eventual licensing of CPMs is inevitable. North Carolina must join the over 20 states, including many of the states bordering us-- Tennessee, Virginia, South Carolina, who recognize CPMs as well-trained birth professionals. I can attest to the rigorous training received by CPMs, where clinical hours double those for many in allied health professions. Before I finish my training, I expect the process will have taken 3-5 years, including clinical hours, self study, ancillary training (such as adult and neonatal resuscitation), and examination process.

    CPMS offer a service (home birth) that many other practioners do not want to, or are forced not to, provide. Given that in NC we are under served by maternity practioners, it is high time that we provided this choice to our citizens: access to Certified Professional Midwives.

    We hope that the study committee will favorably recommend that the issue be put before the entire legislature.

    Again, thank you for calling attention to this issue.

    Sylvia Santaballa,  PhD, CDMarch 27, 2008
    Wilmington, NC

    Hello at advance for Nurses,
    I want to thank you for your article on this very important issue to North Carolina women and their families.
    Homebirth is a childbirth option that should be preserved and protected by allowing the only skilled professional trained specfically to attend out-of-hospital birth in the home: the Certified Professional Midwife.
    I am a registered nurse as well as a student nurse midwife and I have chosen to given birth at home four times with a CPM because I know first-hand the cascade of unnecessary medical intervention often seen in the average hospital birth. For my family the safest way to welcome our children into the world was at home under the care and skill of a CPM.
    I am proud to be a member of the nursing profession and will be equally pround to become a Certified Nurse-Midwife who supports the right of a pregnant patient to given birth where and with the attendant of her choosing. I look forward to one day working with my sister CPMs as we safeguard normal birth for future generations of North Carolina women.

    Ashley  Marshall, RNMarch 26, 2008
    Chapel Hill, NC

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