FAQ

Is out-of-hospital birth safe?
Why does liability/malpractice insurance matter?
How are midwives credentialed?
What is a "birth plan" and do I need one?
What exactly is a "birth center?"
What do I do in the case of a bad outcome and I suspect mistakes were made?
When and why does transfer to a hospital happen? Who makes the decision? What is it like?

Is out-of-hospital birth safe?
There are many factors to consider when answering this question. Among the most important is having the right information about the risks involved (yes there are much greater risks in out of hospital birth), your candidacy for this type of birth (it is not for everyone), and whether or not there are regulations in your state for such practices (if there are not, that is a red flag).

Why does liability/malpractice insurance matter?
A provider who has malpractice insurance is operating under a strict set of guidelines to protect your safety and offer a consistently determined scope of practices. Providers, whether doctors or midwives, who have insurance have to meet standards for professional development, licensing, and operate within a safe scope of practice. In addition, insurance matters should negligence occur. (Please visit our National Media link to see that negligence does occur and often in the US for out of hospital birth.) Insurance matters for families who have a child injured by birth and for families whose babies die from very preventable circumstances. Insurance is a measure of accountability in a profession that is very lacking in being accountable.

How are midwives credentialed?
There are many very confusing aspects to this question. Please see the blog post from April 18, 2012 about this topic to learn more.

I would add that hiring a CNM for out of hospital birth is still no guarantee and does NOT adequately help you understand their scope of practice or philosophy. Just because they hold a Masters degree, doesn't help you determine how they will make decisions or act in the face of crisis. The majority of Nurse Midwives function in the hospital setting in some capacity. If you're looking for out of hospital birth, carefully consider and discuss philosophy, scope of practice, transfer guidelines, definitions of risk, and so on. The difference is that with a CNM, a licensed provider, you have some recourse through the state appointed board when they do act negligently b/c they are licensed. A CPM can walk away without so much as a reprimand in MI.

What is a "birth plan" and do I need one?
A birth plan is a document that outlines your wishes for your ideal birth. I also think that some women have a "vision" in their minds for how they would like their birth to go. It's okay to think this through and talk about it with your care provider, but the bottom line is that Safety Trumps your Vision. Bringing your baby home alive matters more than giving birth in a candle-lit room or a tub. No matter what your "plan" or "vision" might be, and no matter who your care provider is, they need to be very clear about defining risks and what is safe/not safe. You need them to ere on the side of caution and keep safety at the forefront. I always recommend a second opinion when in doubt or even just for good measure.

What exactly is a "birth center"?
There are two kinds of birth centers, those affiliated and overseen by a hospital and those that are not. The latter are called "freestanding" birth centers. In MI there are currently NO, I repeat NO as in NONE, regulations, rules, or oversight for freestanding birth centers. What does this mean? It means they police themselves and do whatever they want. Anyone can open a birth center (even midwives who have had credentials taken away or had repeated infant deaths...see the Michigan Media Link from Channel 7 news, Detroit). Midwives working there will sell it as a good thing, when really it means there is no oversight, review process, or recourse when negligence occurs. Bottom line, hospital birth centers have access to emergency support, freestanding birth centers are dangerous.

What do I do in the case of a bad outcome and I suspect mistakes were made?
 I hope than none of you read this after a tragedy has happened, but too often that's the case. If you live in MI and have experienced birth injury or infant mortality, there are a few things you can do...

On a Civil Front: Find a lawyer that will represent you. (This is hard b/c many midwives don't have insurance. It's difficult for lawyers to spend years and time and money, when they know they'll never be paid for their work.) In MI, I recommend Brian McKeen of McKeen and Associates in Detroit.

If Your Midwife is Licensed (CNM): You need to visit the website for Licensing and Regulatory Affairs at Michigan.gov. Here you will find links for filing an allegation against a licensed care provider. It takes times, but this is the only way the nursing board will review your case and determine consequences. This also ensures that the licensee will have the events permanently on their record for others to research. Otherwise, midwives are NOT required to report their outcomes.

If Your Midwife is NOT licensed (CPM or Lay Midwife): You can visit North American Registry of Midwives (NARM) website to learn how to file a complaint. Your compliant will not be confidential, they will send copies of everything to those accused. (Please see the blog post about experiences with NARM.) You'll need to make your own decision about whether this is a process that is comfortable for you.

On a Criminal Front: You need to report your experience to the police. They will evaluate with your county prosecutor whether or not criminal charges are warranted. Even if you don't press charges, alerting the county prosecutor that this is a problem will help them see and advocate for the need for regulation. You voice matters.

* If you were transferred to a hospital, you need to ask for a copy of medical records for you and your baby to know what was reported about your labor/delivery.

When and why does transfer to a hospital happen? Who makes the decision? What is it like?
First of all, transfer to a hospital when you planned an out of hospital birth DOES NOT MEAN you failed in any way. It means you are taking steps to keep yourself and your baby safe because you need help. Sometimes mothers initiate transfer, and in that case, trust your instincts and GO. That being said, your midwife is responsible for assessing, recognizing, and acting upon signs of danger and furthermore, has the professional responsibility to TELL you that more advanced care is needed. It should NEVER be a situation where the midwife backs off and tells you to make the decision when you are in the middle of labor, and it should NEVER feel like they are trying to stall or keep you there longer than it feels comfortable. (See blog post about Transferring to the Hospital for more details about what this experience is like and what you need to know.)