Beyond the hospital delivery room
Dyer resident Zara Fagen is a research scientist with a Ph.D. in neurobiology, and as she prepared for the birth of her first child, she never envisioned anything outside of a hospital room.
“I was all ready to go the medical route, but I knew I wanted to have the ability to walk around during labor, do it without drugs and not be induced,” Fagen said. “I locked horns with my doctors as I got closer to my due date. They seemed less likely to honor my requests.”
Fagen did some research on homebirths and determined that low-risk births at home with a qualified professional midwife can be as safe as a hospital setting.
Fagen turned to a midwife when she was 30 weeks along, and she delivered a healthy baby about two months later.
“It’s not for everybody, and you have to be willing to take responsibility if something goes wrong,” Fagen said. “But I was incredibly happy with it and thought it was an awesome experience. I always knew I would transfer to a hospital if risks occurred.”
Homebirths are legal in Indiana, but until this year, midwives who attended homebirths operated in a legal gray area. If some complications occurred during the birth and the mother had to be transported to the hospital, a midwife could be charged with practicing medicine without a license, which is a Class B felony.
This spring, the Indiana General Assembly passed legislation that creates a pathway to obtain Certified Professional Midwife certification from the Indiana Medical Licensure Board. The state is expected to start accepting applications on Jan. 1, 2014, but a board composed of midwives, nurses and doctors must be established and they will make recommendations to the licensure board.
Fagen said the bill is very consumer friendly, in that it doesn’t make it easy to be a midwife.
“It requires extensive training and education,” Fagen said. “I don’t think consumers realize that not all midwives in the state have the same training. It requires midwives to have the highest level of modern understanding of the birth process.”
There are two types of midwives: certified nurse midwives, who typically operate in hospitals, and certified professional midwives, who deliver babies at home. The state has about 12 CPMs who have obtained credentials in other states.
The certification process will require midwives to complete coursework at accredited schools, and Kouts midwife Cindy Lybolt hopes to be one of the first under the new system.
“Midwifery is shared responsibility,” Lybolt said. “It’s a blend of science and art. It’s more individualized care. Where you might see your OB for seven minutes max, we talk for an hour about eating, changes in your body, and we talk about the reason behind various tests. We do what’s needed, but it’s not me telling the mom what to do.”
Lybolt, who has attended the delivery of at least 250 babies, said midwives always face a threat of someone filing a complaint with a county prosecutor or attorney general.
“This takes the fear out of going to the hospital,” Lybolt said. “The bill offers accountability. There is a grievance process if someone had a bad outcome.”
Indiana Midwives Association President Mary Helen Ayres said the law isn’t perfect, particularly when it comes to liability insurance and signed collaborative agreements with physicians.
“I practice with a great doctor, but our agreement is informal rather than contractural,” Ayres said. “He lobbied for us, but he doesn’t want to sign an agreement. In modern medicine, a lot of doctors don’t even own their practices; it’s hospital owned or group owned, so they may not be allowed to sign an agreement.”
As far as liability insurance, Ayres is worried that the cost could make the legal practice of midwifery too expensive and force consumers to seek underground midwives.
“A lot of midwives are wondering how this is workable,” Ayres said. “We knew it would increase requirements and we welcome that, but a lot of our clients are upset because it’s not the bill they supported. In Indiana, there’s especially a growing trend of completely unattended homebirths becoming more popular. That’s a really bad idea to have unattended births. Homebirths are good as long as you have trained assistance and a medical backup plan.”
But Ayres is hopeful that the General Assembly will make changes to the bill, and that the Medical Licensing Board will be willing to make changes suggested by the Midwifery Committee.
“A legal pathway is a positive thing of course,” Ayres said. “We’re just really looking forward to getting back to being good midwives.”