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How to find an attendant for birth at home.

"I live in Sioux City, Iowa and I want to have this baby at home. Can you help me find a midwife?" Calls like this are frequent at Informed Homebirth, and fortunately we can usually offer a great deal of help to couples who are looking for someone who will help them with a homebirth.

Informed Homebirth has a computerized referral network of IH/IBP childbirth educators and members throughout the US and Canada. These are usually women who have had their own baby at home and who are up-to-date on who is helping with homebirths in their area. We also can give callers the names of state midwifery organizations and have other directories such as the NAPSAC Directory of Alternative Birth Services and Consumer Guide which have helpful leads.

Finding a skilled attendant is, we feel, one of the most important aspects of having a safe homebirth. In addition to writing or phoning Informed Homebirth, there is a lot of exploration you can do locally. As midwives are becoming more accepted, they often advertise in the yellow pages--check under both "midwives" and "birth centers." Even if attendants at birth centers are not doing homebirths, they often know who is. Reassure them that you aren't asking for their recommendation; rather, you're an intelligent consumer and would really appreciate any names and phone numbers to help you explore the options.

If midwifery is not so visible in your state, you might have to plug into "the grapevine" by putting up a request for information at the co-op or attending La Leche League meetings. Find your local League leader by checking in the phone book or by calling 1-800-LaLeche. Women who go to their monthly breastfeeding support meetings often have more natural lifestyles, and you may find some who have had their babies at home. La Leche League leaders are not allowed to give recommendations, but they can be a wealth of information after the meeting is over.

Certified Nurse-Midwives are practicing in every state, although the majority of them work in hospitals or birth centers. Direct-entry midwives have received their training through the apprenticeship model or by attending a school for direct-entry midwives. Whether a woman is a nurse-midwife or a direct-entry midwife is probably not as important as her experience and orientation toward birth (see the following article on "Choosing Your Attendant").

While direct-entry midwives practice throughout the United States and Canada, the laws governing midwifery vary in each state or province. Some midwives are legal and licensed, while others practice under "gray areas" in the law and still others are completely illegal. It is ironic that in California, which has the greatest number of homebirths, direct-entry midwives are outlaws. The work of reclaiming midwifery as a viable option and getting appropriate legislation are arduous tasks (see "Midwifery Issues" for legislative updates).

In no state is it illegal for you to have a baby at home. There is no law saying you must give birth in a hospital. However, the laws may impact what your midwife does and does not do. Regardless of the legal aspects, the responsibility rests on you as an informed consumer to interview your attendants about their training and experience and make the choices that are best for you.

Is it possible to find doctors who are doing births at home? Many who were have been driven out of practice by peer pressure or soaring malpractice rates. The American College of Home Obstetrics, 2821 Rose St., Franklin Park, IL 60131 is a support organization for physicians. Most areas outside of Chicago do not have doctors who do births at home. "Word-of-mouth" will soon tell you who is attending homebirths in your area.

Finding a skilled birth attendant is a great deal easier now than it was in the past, but it can still require effort on your part. Many of the "friends who were attending friends' births" fifteen years ago have gone on to become experienced and highly-skilled midwives. But some of them are leaving practice now either through burn-out or through the necessity of earning a decent living as they become older, have college-age children, and so forth.

Birth at home, like birth in the hospital, is not without risk. Having a skilled attendant with whom you can communicate easily can make all the difference in preventing problems, recognizing complications before they become emergencies, and assuring quick action in the rare circumstances when emergencies arise.

We hope that by following the suggestions in the preceding article you will be able to find several midwives whom you can interview (in a few states you may also find doctors or chiropractors doing births at home). Regardless of whom you find or what titles they may or may not have after their name, the initial interview can give you important information to help in your decision-making process.

Most homebirth attendants assume that you are taking a great deal of responsibility for the birth of your child and usually welcome your questions. The following guidelines can help you know your attendant better:

1. Training and Experience

Is her training through the apprentice-model (direct-entry midwifery), or through a training program (certified nurse-midwife or direct-entry)?

How many births has she seen and at how many was she primary attendant? What is her orientation toward home/hospital? Is there certification in your state, and does she have it?

2. Complications and Emergencies

What complications and emergencies has she seen and how were they handled? What emergency equipment, herbs and medications does she bring? What does she do about broken waters, meconium staining, lack of progress? What is her transfer rate? Does she do episiotomies? What if you tear, does she suture?

3. Medical Backup

Does your attendant have hospital privileges or a backup physician? Do you need to see a physician during your pregnancy? How is lab work done? If you need to transfer to the hospital, will your midwife go with you? Does she recommend a pediatrician? You should develop your own list of emergency backup numbers to keep by your phone (there is a worksheet on page 50 of Special Delivery to help you).

4. Supplies and Procedures

What does she bring, and what does she expect you to have on hand? Who comes with her? Does she do labor support as well? Can you delivery in any position? How long does she stay after the birth? When does she cut the cord? How does she suction the baby? What other things do you want to know?

5. Fees

What does her fee include? When does she want payment, and what is her refund policy in case of transport? What other expenses can you expect (lab work? RhoGam if Rh negative?)? What about childbirth classes? Does she do postpartum visits?

6. Communication and Attitude

How do you feel about this introductory session? Were your concerns heard and acknowledged? Were you able to communicate about what you wanted? What is her attitude toward birth, and does it seem to mesh with yours? Are there any major differences? What role do you see your attendant playing in the labor and birth (active/guardian/sister/health professional/or?) Does she feel comfortable with this?

You may not be able to find the ideal birth attendant (the one of your best imaginings). Instead you will find real men and women who are concerned with the quality of birth and are, either tentatively or boldly, helping with homebirths. The more you can communicate with your attendant, the better friends you will become, and the fewer surprises you are likely to have at the birth itself.
COPYRIGHT 1992 Association of Labor Assistants & Childbirth Educators
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 1992, Gale Group. All rights reserved. Gale Group is a Thomson Corporation Company.

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Title Annotation:includes related article on choosing your attendant
Publication:Special Delivery
Date:Mar 22, 1992
Previous Article:Advantages of homebirth.
Next Article:You're having your baby where???

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