If she does, a midwife who has gone through the national certification program, but is not a nurse and is not affiliated with a physician or hospital, risks arrest.
The state's ban on certified professional midwives, CPMs, is outdated -- a view shared by Rep. Winkie Wilkins and a bipartisan group of state legislators who have introduced House Bill 522, which would establish a licensing process and board for professional midwives.
"There are some folks out there who want to have that experience at home," Wilkins said Wednesday. "... The midwives that I've encountered certainly seem committed to what they're doing and they seem to know a great deal about what they do."
Wilkins' Republican cosponsor Rep. Bill Current, a dentist, argues that giving patients the option of working with CPMs is another way to harness medical costs in North Carolina. An uncomplicated vaginal birth at home costs, on average, less than a third of what it does in a hospital, for essentially identical outcomes.
The North Carolina Medical Society, which represents physicians, predictably disapproves.
"Basically, we feel that the licensure of certified professional midwives poses a significant risk to public safety, and essentially validates illegal practices," said Mike Edwards, the group's director of media relations. "... We have reached a standard in North Carolina where we have the best-qualified people prepared to deliver babies and have both the mother and the baby and their safety in mind as they do these deliveries."
But the evidence strongly suggests that CPMs are not necessarily a public health risk, nor underqualified. In 2005, the British Medical Journal published a large study that compared low-risk hospital births with all American and Canadian home births attended by CPMs. The researchers found that the 5,418 women who gave birth at home and the 3.3 million who gave birth in hospitals had strikingly similar rates of neonatal death -- 1.7 deaths per 1,000 babies -- and none of the mothers attended by midwives died.
Furthermore, the women who planned to give birth with the help of midwives at home were less likely to require medical interventions, including episiotomies (2.1 percent versus 33 percent at hospitals), vacuum extractions (0.6 percent versus 5.5 percent), caesarean sections (3.7 percent versus 19 percent) and electronic fetal monitoring (9.6 percent versus 84.3 percent).
One important point: The study did not break out the outcomes for CPMs based on their training, which can vary dramatically.
Deb O'Connell, the owner of Carrboro Midwifery, holds both a CNM certification and a CPM. O'Connell believes in licensure, with some reservations.
"With licensure comes accountability," O'Connell said, but "it really bothers me that there's no standard of education within their credential. They say there is, but there isn't. They can become a CPM with nothing more than a high school diploma" and an apprenticeship.
In all, H.B. 522 represents a timely idea, but there are caveats. The bill should include a requirement that CPMs must carry malpractice insurance, and the state's licensure board, once established, should set educational and ethical standards beyond those implied by national certification.
