Midwifery and Home Birth Care in North Carolina as Compared with the Republic of Ireland
Creators: name: McElligott, Kara
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2007

description: In the United States and in the Republic of Ireland the majority of births occur in a hospital or hospital birth center. Reasons for this include strong historical precedents, social norms as well as economic drives including hospital marketing. Issues about birth setting have an influence on approximately 4 million births in the United States each year. In the U.S. and Ireland, home childbirth is a controversial issue. A growing number of mothers are seeking to deliver their infants at home. The practice of planning the delivery of an infant in the home, with a certified nurse-midwife attendant, has not been associated with significant adverse maternal or infant outcomes in low risk pregnancy. In fact, in some studies home childbirth has been associated with positive outcomes and a variety of benefits compared with hospital births. In North Carolina, the demand for home birth deliveries is not being met by licensed providers and mothers who arrange deliveries attended by unlicensed providers may be at increased risk of avoidable maternal and infant morbidity and mortality. Data on characteristics, safety and benefits of home births are primarily observational. For instance, the number of home births is estimated to be about 2% in both North Carolina and Ireland. However, according to a personal communication with a certified professional midwife, some mothers who have a home delivery in North Carolina may not apply for a birth certificate. These home deliveries may go unrecorded. In addition, in North Carolina, because of the shortage of licensed attendants willing to provide a home childbirth, unlicensed midwives may be attending home births. Even less will be known about the outcomes of these deliveries. Are the mothers who are acquiring the services of unlicensed midwives being put at risk? More information about what mothers are choosing a home birth and who is attending home deliveries in North Carolina are needed in order to determine what systems can be put in place to protect mothers and infants from potentially avoidable mortality and morbidity. The purpose of this analysis is to also improve understanding of how factors such as policy, legislation and reimbursement of home birth influence the deliveries of mothers choosing home birth in North Carolina and Ireland. Understanding how these forces may inhibit access to cost-saving, potentially effective, and presumably beneficial alternatives to hospital delivery is important for future policy, research and obstetrical care practice decisions in North Carolina. This paper will analyze the feasibility of three possible options to improve on the lack of information and risk to safety in mothers seeking home birth in North Carolina. While there may be many others, these themes were prevalent in discussions with various elite informants and key stakeholders. The options are: A. Instituting a requirement that no out-of-hospital deliveries occur. B. Promoting an increase in the number of certified nurse-midwives in North Carolina. C. Promoting legalization and therefore regulation of certified professional midwives in North Carolina. These three options will be analyzed in comparison with current policies and practices.