By John Murawski
The News & Observer (Raleigh, N.C.)
WWR Article Summary (tl;dr) As John Murawski reports, “an underground culture of home births, assisted by illegal midwives, thrives in North Carolina among women who seek an alternative to what they perceive as a sterile, mechanized and unhealthy childbirth industry controlled by doctors and hospitals.”
The News & Observer (Raleigh, N.C.)
Ashley Kopp-Houston was in her 81st hour of labor, too weak to walk on her own, when her midwife insisted it was time to go to the hospital.
Kopp-Houston was having her first baby and had wanted a natural home birth: without medications, without doctors, without electronic monitors. But three days into labor, the baby wasn’t making progress, and her midwife was increasingly concerned. She convinced Kopp-Houston to go to UNC Hospitals in Chapel Hill, and accompanied her undercover — as her doula — because she was practicing midwifery illegally in North Carolina.
The next day, Kopp-Houston, at age 38, gave birth to a healthy girl weighing 7 pounds, 14 ounces.
To this day, she won’t name her midwife, even though she says the woman has retired.
North Carolina is one of six states that forbids certified professional midwives from delivering babies, and providing prenatal exams and other maternal care, according to the North American Registry of Midwives.
The ban, in force since the state established regulations for midwifery in 1983, has been occasionally enforced by court orders against certified professional midwives who have been caught practicing without a license.
The state does allow nurse midwives, who practice under the auspices of a doctor, but because few nurse midwives perform home births, the market for certified professional midwives has not entirely disappeared.
“It just forces things further underground,” said Nancy Koerber, a certified professional midwife who now works in administration as executive director of WNC Birth Center in Asheville, in a phone interview. “It makes people more rebellious.”
Indeed, an underground culture of home births, assisted by illegal midwives, thrives in North Carolina among women who seek an alternative to what they perceive as a sterile, mechanized and unhealthy childbirth industry controlled by doctors and hospitals.
The number of home births in North Carolina has doubled over the past two decades, exceeding 600 every year since 2010, even as all births statewide have stayed relatively flat.
A practice that a century ago was associated with poverty is now sought out by women, often college educated and able to pay in cash. That last is an important point, since a typical certified professional midwife charges between $2,700 and $3,200, based on interviews, and her services are not covered by health insurance. Blood tests, urine tests or ultrasounds all cost extra.
The renewed popularity of midwives has led hospitals across the state to add nurse midwives to their staffs, as The News & Observer has previously reported. And now, the prospects for legalizing certified professional midwives in North Carolina appear brighter, as these midwives have agreed to expand their professional credentials.
‘I don’t want to be treated as a criminal’
“To be laying in my bed, in my home, holding my daughter, an hour after I birthed her, in my bathtub, in my home — I wouldn’t have traded it for anything,” Crissy Rollins, 40, a licensed massage and bodywork therapist who home-birthed in Garner in 2013, said in an interview last year.
“I helped pull her out and lift her up and immediately start nursing and holding her, and she was in my arms a full hour,” Rollins said.
The certified professional midwife who assisted Rollins was Jamie Perkins, who was forced out of business. Just months after delivering Rollins’ daughter, Perkins said she received a home visit from two N.C. Board of Nursing inspectors while providing pre-natal services to another client. Perkins was slapped with a cease-and-desist order and soon after signed a consent form, agreeing to stop practicing midwifery without a license, which is a misdemeanor under state law.
Perkins, who is also a trained emergency medical technician and teaches CPR classes, agreed to be named in this article because her disciplinary action is a matter of public record and she says she no longer practices midwifery.
“I don’t want to be treated as a criminal; I want to be integrated into the [health care] system,” said Perkins, at her home in Princeton, an hour east of Raleigh. “You can regulate me all you want, just let me work.
“It’s my calling and a lot of my identity, and I’ve not had that for so long.”
Certified professional midwives, who spoke with The News & Observer for this article said they have long stopped performing illegal home deliveries, but they said they know of plenty of others who deliver “under the radar.”
Obstacles to working legally
Currently, to become a certified professional midwife, a student must learn assigned study material, apprentice with an experienced midwife and pass a certification exam administered by the North American Registry of Midwives, or NARM.
A certified professional midwife typically studies at least three years and participates in at least 55 deliveries as an observer, assistant and primary caretaker before becoming certified, according to NARM. But they aren’t required to have nursing degrees or college diplomas.
That will change in 2020 under a deal struck between national organizations that represent obstetricians, gynecologists and midwives with nursing degrees. Certified professional midwives will have to graduate from one of the country’s 11 accredited midwifery schools, or complete 50 hours of additional training in emergency procedures and other skills, to hold themselves out as certified professional midwives.
The American College of Obstetricians and Gynecologists, or ACOG, estimates that as many as two-thirds of the nation’s 2,300 certified professional midwives lack the level of training that the 2020 standards require.
Charlotte obstetrician John Allbert, a past president of the N.C. OB-GYN Society, said the 2020 standards represent “a pretty extensive education” that could tip the scale in favor of letting certified professional midwife work legally in North Carolina.
“If they met the criteria, then we could discuss how we could integrate them into the system and maintain the safety of women and babies in North Carolina,” said Allbert, who also is active in ACOG.
Any effort would require the state legislature to act. Bills to legalize certified professional midwives are introduced in the North Carolina General Assembly year after year, but don’t get very far. Former state Sen. Thom Goolsby, whose wife had two home births, sponsored legislation, and after leaving the legislature in 2014, lobbied for N.C. Friends of Midwives in 2015 and 2016.
But state Rep. Donny Lambeth, a Republican from Winston-Salem, said he has spoken to obstetricians and gynecologists who are increasingly open to including midwives in the health care system. These doctors know there is a chronic shortage of doctors in the state’s rural counties, he said, and added that low Medicaid reimbursements are forcing doctors to look for ways to be more efficient.
Lambeth has four decades of experience in health care and was formerly CEO of Wake Forest Baptist Medical Center in Winston-Salem. The chairman of two health care committees in the state House of Representatives in the last legislative session, Lambeth said that properly trained midwives, combined with telemedicine, could provide much needed services in remote areas that lack access to prenatal health care and have high infant mortality rates.
Still, any legislation to legalize certified professional midwives in North Carolina would likely limit them to caring for women with low-risk pregnancies and would impose other stringent restrictions.
Even with that backing and those limitations, certified professional midwives still face obstacles to working legally. A major concern for doctors is that these midwives deliver in private homes, and home births — though legal — are viewed as unsafe by many medical professionals, because unanticipated complications outside a hospital can put a newborn at risk of death or brain damage.