This article first appeared in the St. Louis Beacon, July 26, 2013: This June marks the fifth year since the Missouri State Supreme Court decriminalized certified professional midwives in the state.
While home birth has never been illegal in Missouri, midwives were banned from delivering babies outside a hospital, leaving many families with limited options.
One such family is that of Summer Thorpe-Lancaster.
Her first childbirth, in a hospital, was an experience she describes as “pretty negative. The nurse asked what had I done to the doctor because she was punishing me. I knew there had to be a better way.”
A few years later Thorpe-Lancaster moved to Florida, where home births attended by midwives were legal. Excited to see a culture of midwife acceptance she says, “I looked in the Yellow Pages, called a midwife and told her ‘I think it's great you are in the Yellow Pages!’ and then I hung up. A few months later I called back when I got pregnant.”
When she returned to St. Louis in 2008, pregnant again but before the legislation was passed, Thorpe-Lancaster called a family friend who was a midwife.
“It's really hard to ask someone you know and love to put their life on the line, where they could go to prison if caught. We had to be pretty careful. Only close friends knew about her." When it came time for her labor, Thorpe Lancaster said she filled out her own charts "in case there was a complication and I needed to go to the hospital. (That way) there would be no obvious signs of her.”
In 2010, after the legislation had passed, Thorpe-Lancaster was pregnant for the fourth time. She describes the home birth experience as “amazing.”
“I called [the midwife], called insurance, paid her with checks and even got to write midwife in the memo line! It was so cool to be able to do that, to be able to talk about it very openly.”
Since 2007, out-of-hospital births have increased by 68 percent, with births attended by certified professional midwives doubling between 2010 and 2012. Of the 1,420 out-of-hospital births in 2012, midwives assisted in more than 1,000 of the deliveries, according to the Friends of Missouri Midwives.
Practiced in cultures around the world, midwifery is a profession in which non-physician providers offer care to childbearing women during pregnancy, labor and birth, during the postpartum period, and between pregnancies.
Despite its early historical significance, as medicine gained legitimacy and power in the early 1900s, midwives were viewed as second tier to physician-attended births.
The turf war between midwifery and medicine has been long-running. Both the American Medical Association and the American Congress of Obstetricians and Gynecologists — professional groups that write official medical and obstetrics guidelines in the U.S. — oppose home birthing on grounds of safety.
In 1998, the National Center for Health Statistics and the Centers for Disease Control released a study finding that “the risk of experiencing an infant death was 19 percent lower for births attended by certified nurse midwives than for births attended by physicians.”
But such statistics don't tell the whole story, said Dr. Gordon Goldman, the Missouri section chairman of the American College of Obstetricians and Gynecologists. "Most of the time, they are going to get away with [a midwife birth], but when [a death] happens, even if it's one in 1,000, it's 100 percent for you and your baby," he said.
One contributing factor to these positive statistics may be that midwives generally will not accept high-risk patients — sending them to doctors. Pregnant women who are extremely overweight or diabetic, drug users, or those who have a history of hemorrhaging are more likely to be rejected by a midwife. This means that childbirth statistics for doctors might be less favorable simply because they’re treating a higher proportion of risky patients.
Sarah Greek, a spokeswoman for Friends of Missouri Midwives, an advocacy group for midwifery, said, “I believe any woman should give birth where she feels safest, empowered, and educated to make the best decision for her and her family. I have nothing negative to say about (the) hospital experience; each provider is going to have things they are strong in and liabilities. But it is the right of the woman to have the freedom to make that choice.”
Dr. Elizabeth Allemann, a family physician from Columbia with 20 years experience, supports the 2008 law and speaks on behalf of Friends of Missouri Midwives. "Legal home-birth midwives mean we can all be open and honest about what has happened and why, and what the plans are in the future," she said in a press release. "I can't tell you how much more comfortable, complete, and safe the care I provide is now, compared with the past, when families felt the pressure to protect their midwife. Now I have the chart, and the midwife often calls before or accompanies the family to the visit. Open is better.”
Thorpe-Lancaster says she hopes her own experience will persuade others: “Once you go midwife, you never go back.”