Michelle Breen had all her factual ammunition on hand, and living proof of
her joy in midwifery running around her living room: a healthy, happy,
nursing child with little reverence for journalistic procedures.
Breen, of Louisville, is president of the Kentucky Alliance for the
Advancement of Midwifery. That's a somewhat labored title for a non-profit
group designed to educate the public about midwives -- women who assist
pregnant women with prenatal care, childbirth and care of the newborn, often
in special "birthing centers" or at home.
The alliance serves as an information center for interested parents across
Kentucky and Southern Indiana. Call (502) 893-3727 for more information.
It's preparing a campaign to allow lay midwives -- or "direct entry
midwives" in its terminology -- to once again be regulated and licensed in
Kentucky. No new applications to practice lay-midwifery in Kentucky were
allowed after April 1975. Experienced lay midwives were allowed to continue,
but few of those remain.
As uncommon as it now seems, midwives were our primary birth attendants
throughout history, mostly in our homes. The alliance offers one
informational nugget that may be as interesting as it is irrelevant: The
only two U.S. presidents not born at home were Jimmy Carter and Bill Clinton.
Times, medicine and medical public relations have changed. At last count 36
states restricted or prohibited the practice of lay midwifery. These
prohibitions do not apply to certified nurse-midwives, who are registered
nurses with two years of advanced training and who usually work under a
doctor's supervision in a clinic or hospital.
Of the estimated 10,000 midwives in the country, about 4,000 are certified
nurse-midwives and 6,000 are lay midwives who enter the profession from
independent midwifery schools or through apprenticeships. They are supposed
to be trained to meet state requirements, then be licensed. Most lay
midwives practice without direct supervision by a doctor. The majority of
them are with religious groups such as the Amish.
You can see the alliance's public relations problems; all it has to overcome
is Kentucky regulations. lack of insurance for midwifery care, general
physician resistance and a poor public perception, fostered in the movies,
about "birthin' babies" at home. For all that, its demand is growing.
The alliance and Breen are not without ammunition. For all its medical shine
and polish, the United States has the fifth-highest infant-mortality rate
among Western industrialized nations. It has the second-highest Caesarean
rate in the world. Breen estimated the average cost of delivering a child at
home is $1,200, much lower than a hospital birth. While about 4 percent of
U.S. births are attended by midwives, about 75 percent of births in Europe
are attended by midwives.
But statistics are not the full story. Many women fear giving birth at home;
what if something goes wrong? Breen answers that those instances are rare;
midwives can handle them or send the mother to a hospital if need be. Her
statistics say midwife-assisted home births are as safe as -- if not safer
than -- hospital births.
She does not want lay midwives practicing without professional training or
licensing, hence the upcoming push to get Kentucky to end its prohibition.
She said the need for midwives, for better pre- and post-natal care, drives
her push for change. Because of need, she also knows there are women in
Kentucky illegally practicing lay midwifery.
Nationally, Breen said, midwifery has become much more professional. She
cites agencies such as the North American Registry of Midwives and Citizens
for Midwifery. They promote the medical and emotional benefits, the
nurturing, sharing feelings not always found in a hospital.
Breen -- and a certified nurse-midwife practicing at a birthing clinic in
Hardin County -- will speak to an education committee of the
Louisville-Jefferson County Board of Health on Monday.