Unassisted: Home Birth in Nebraska, Part Two

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February 6, 2012 - 6:00pm

Editor's note: This report is part two in a two-part series. You can find part one here.

Nebraska Sen. Tony Fulton of Lincoln wants to repeal a single line in Nebraska's medical laws: the one prohibiting certified nurse midwives from attending home births.

"Here's a conservative Republican saying we ought to be progressive when it comes to home births," he said. "A bit of irony there, but this is not a conservative/progressive thing. This is rational, common sense. This is what we should do."

Fulton was approached by Nebraska mothers years ago, asking for his help. The advocacy group Nebraska Friends of Midwives would visit the Capitol, handing out M&M cookies to legislators to remind them of "mothers and midwives."

Photo courtesy of the Nebraska Friends of Midwives

Nebraska Friends of Midwives at the Nebraska Capitol

Home birth statistics

Key findings from a U.S. Centers for Disease Control report on home births in the United States from 1990 to 2009.

  • After a decline from 1990 to 2004, the percentage of U.S. births that occurred at home increased by 29 percent, from 0.56 percent of births in 2004 to 0.72 percent in 2009.

  • For non-Hispanic white women, home births increased by 36 percent, from 0.80 percent in 2004 to 1.09 percent in 2009. About 1 in every 90 births for non-Hispanic white women is now a home birth. Home births are less common among women of other racial or ethnic groups.

  • Home births are more common among women aged 35 and over, and among women with several previous children.

  • Home births have a lower risk profile than hospital births, with fewer births to teenagers or unmarried women, and with fewer preterm, low birthweight, and multiple births.

  • The percentage of home births in 2009 varied from a low of 0.2 percent of births in Louisiana and the District of Columbia, to a high of 2.0 percent in Oregon and 2.6 percent in Montana.

"For them to be stigmatized as strange or awkward, it's the ultimate of ironies, because these are moms," Fulton said. "And often times the stigmas are being foisted upon them by those who are not moms."

Jessica Freeman is a mother of three and a board member of Nebraska Friends of Midwives. During her first pregnancy, she said that like most newly-expectant mothers, she read many books on childbirth. But when it came time to deliver, she said she experienced interventions by hospital staff she felt might not be safe.

Her doctor broke her water, and told her to push - an urge, Freeman said, she never had.

"I came out feeling just not sure what I was doing," Freeman said. "I didn't ever have the urge to push, you know, I didn't have that confidence, that sense of, I can do this.' And that translates into your mothering."

That experience led Freeman to seek out a home birth for her next two children. Her first home birth was performed in New York, and despite the ban, her second was in Nebraska.

"We're not looking for 50 percent of births to be in the home," she said. "We're just saying we want the ones who know about home birth, want to be able to have a safe home birth - we want to be able to have an attendant there, to make sure nothing goes terribly wrong and to help us if something does go wrong."

But the Nebraska Medical Association said Nebraska's laws should stay as they are.

"The reason that the physicians and the medical community is concerned about this issue have to do with the health and the safety of the mother and the child," said David Buntain, a lobbyist for the Nebraska Medical Association.

Any attempts to repeal the home birth provision, he added, will never be supported by the NMA.

"You're making a decision, not just for the mother, but also for that child who's being born," he said. "And the child doesn't really have a say in it. And I would think the child would want to be born in an environment where he or she has the best chance to have a normal birth."

Sarah Jacobitz-Kizzier is in her final year as a University of Nebraska-Medical Center student, and plans to become a family physician. A KVNO News reporter asked her why she thinks the medical community is resistant to allow home births.

"Fear of lawsuits, losing their own medical license, of losing prestige in their community," she said. "All these things are scary to new professionals, to new medical students."

Jacobitz-Kizzier said in medical school, the practice of home birth is never brought up. And often, she said, the topic was "taboo" with fellow med students.

But she said women should have as many options as they want, and that there are widespread misconceptions about women who want home births.

"The one that is most polarizing and the most untrue, is the (one) that women who choose to do home births are labeled as having a stronger emphasis on the process of the birth rather than the outcome," she said, "which is totally untrue."

State Sen. Ken Haar of Malcolm

State Sen. Tony Fulton of Lincoln

The Nebraska Medical Association isn't the only group against home births. The American Congress of Obstetricians and Gynecologists said that "although the absolute risk of planned home births is low, published medical evidence shows it does carry a two-to three-fold increase" of complications.

But Jacobitz-Kizzier disputes that idea. She cited a 2009 study from the British Journal of Obstetrics and Gynaecology that found there was no difference in risk for home or hospital births.

When it comes to the state's interest, Buntain said, "The issue really is what's best for the people of Nebraska, and the Medical Association believes that it is not in the best interest of women of Nebraska for the state to allow home birth."

Early last year, Sen. Ken Haar of Malcolm introduced a bill that would repeal the current statute. But Haar withdrew the bill to allow another by Sen. Fulton to pass without issue. Fulton's bill made it more likely hospitals would consider hiring a certified nurse midwife. Sen. Haar reintroduced his bill in January, but is unsure it will make it out of committee. Health and Human Services Committee Chairperson Sen. Kathy Campbell said she can't comment on potential bills, add the she'll have to "wait and see." A hearing on the bill is scheduled for Feb. 22.

Sen. Fulton, however, said it's something that needs to change.

"Virtually every other state allows this except Nebraska," he said. "Either Nebraska is going to be the safest place on the planet to have babies, or it's going to stick out like a sore thumb."



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