Home Birth Story: Women deserve not to be their own midwives

I feel compelled to share the perspective of an Ex-CPM student and her experience(s) with home birth.  Please note the inconsistency in practice or standards of care among CPMs.  

"I had two home births attended by certified professional midwives (CPMs). I gave birth to my children amidst my own training to become a CPM. I apprenticed with a number of CPMs and was enrolled in a MEAC accredited midwifery program. I add these details because I was not the average pregnant and laboring mother – I had experience witnessing and participating in home births, and I had knowledge of midwifery and standards of care for pregnancy and birth.

I value and cherish that I’ve given birth my babies at home. I had no unusual reason for birthing at home: I wanted woman-centered, family-centered care,  I wanted to avoid drugs or procedures in absence of complications, I believed my body knew how to give birth, and I wasn’t afraid of the pain. I appreciate the midwifery model of care – I personally selected and knew my midwife, and knew she specifically would attend me during labor and follow up with me postpartum.

I have a lot of conflicting thoughts on home birth due to my experience with it in many different roles. As having been a doula, an apprentice, a home birth assistant and a midwifery client I am intimately aware of the many shortfalls of home birth and “professional” midwifery.

Recently I learned the term “black hole” used to describe what is lacking in midwives’ training. It is so perfect to describe what is missing – it is a black hole – and because no light escapes a black hole – no one is really aware of the lack in knowledge or skill. It’s just missing. Absent.

I had knowledge and experience with many area midwives, but choosing my midwife was quite hard. Because as much as they provided “woman-centered” care, they also provided care that was based on their own personal fears and biases and superstitions. Maybe these weren’t black holes, per se, but there were voids in my care that I knew I would have to fill somewhere else.

For instance one of my midwives did not use the Doppler during prenatal care. (I believe she had one for waterbirths, I’m not certain). Because I knew many midwives in my community, I could ask a friend to meet me in a parking lot and get heart tones in the first trimester of my pregnancy. Which is what I did. 

One of my midwives sort of eschewed routine prenatal blood work. So I found a friend (a midwife) who would do my prenatal blood panel and 28 week blood work.  I was filling in the holes in my care – to create the care I wanted.

Neither of my midwives made any recommendation about finding a back-up hospital provider during my pregnancy. I did this. Twice. With two different area physicians. Both physicians were willing to come in to take over my care during labor if a transport to the hospital was necessary. Both physicians were agreeable to backing up my home birth plans and ordering any tests (BPP or U/S) if there became reason  to do so during my pregnancy. I would not have given birth at home without this arrangement – though neither CPM during either pregnancy ever mildly suggested that I do this.

The CPMs I hired for my care had very different postpartum follow up care than the care that was provided in one of my apprenticeships. There was virtually no postpartum instruction regarding how to care for my baby, myself, or warning signs that would necessitate immediate medical attention. I couldn’t tell if these things were being omitted because they assumed I knew them already as a student midwife, or if it wasn’t a part of their routine care at all. I knew postpartum instructions and things to look for because the midwife I apprenticed under did this quite thoroughly. But again, this created another hole I had to fill.

I go back to how much I appreciate that home birth was an option for me – but I don’t know that I can recommend home birth with either of these midwives to anyone – and for various reasons.

And after working with many midwives, and being attended by two different CPMs for my own births, it has really struck me how there is NO STANDARD of care by these “professionals.”

If anyone were to ask me to recommend midwife “A” or midwife “B” as their maternity care provider, I would feel obligated to give a list of things that they don’t do: “You’ll have to find someone to do your prenatal lab work.” “They’re superstitious about vaccines/GBS screening/hospital back-up. “ “She won’t use a Doppler during prenatal appointments, so you might not hear the heartbeat.” “She doesn’t work with trained assistants.” “She won’t recommend any physician to provide back up, but Dr Y and Dr Z are two who will back up home births.”

It is hard for me to think that this type of care was OK for me, but not for anyone else. The only reason why it was OK for me is because I knew how to fill the holes. Maybe I’m just justifying it in hindsight. But in both circumstances – and for different reasons – I felt I had to midwife myself at some point during each pregnancy and labor and postpartum. This was substandard care. And, it was the best I could get.

Women seeking midwives deserve to *not* have to be their own midwife. They deserve to have all the holes filled, and all the care provided. Even if that care goes against the midwife’s personal beliefs. (And to be clear, we’re not talking pro-life/pro-choice/religious beliefs – we’re talking about things like routine blood testing , routine lab specimens, hospital back-up arrangements , and auscultation of fetal heart tones with a Doppler.)

If I could have hired a certified nurse-midwife (CNM) to attend my home birth, I think would have. It is legal in my state for CNMs to practice out-of-hospital, it is just very rare. It is also legal in the nearby neighboring state for CNMs to practice out-of-hospital. Again, it is very rare. There was no CNM practice providing home birth services within a hundred of miles of me. There were at least two dozen CPMs or “other” midwives in my area who would attend my home birth.  CPMs are legal in my state. And I was training to become a CPM. Naturally, I chose a CPM to attend each of my homebirths.

Both of my home births went well. And every issue that came up in labor was handled in a sufficient manner.

But I cannot recommend these midwives.  And I have not.

And I have a hard time recommending home birth with a CPM to anyone these days." 


Someone recently described the gaps in a CPM's training and education to be much like Swiss cheese.  Depending on the program of study and your preceptor, skills slip through the cracks.  Safer Midwifery for Michigan is advocating for consistent standards for education and training of midwives.  Clients can be informed, but using the term "midwife" to describe your profession should stand for something we all can count on.