Wednesday, October 27, 2010

CPM Licensure for Pennsylvania

I was asked to make a consumer presentation to the Pennsylvanian Board of Medicine yesterday on behalf of Certified Professional Midwives for their appeal for licensure. This was my presentation to the Board. It was a very long day and a long trip to Harrisburg, but access to midwife CPM is the right of every woman who desires it.

In February of this year, in attendance with my husband, I delivered a beautiful baby girl. While obtaining care from an obstetrician and preparing to deliver in a hospital, we found that the journey to our baby’s delivery took some unexpected turns. You see, as a board-certified and fellowship-trained physician, I had only been exposed to birth in a hospital setting. I did not realize that there was any other option. However, after much research, reading, and asking questions, at 34 weeks pregnant, we made the decision to have a home birth. Of course, the number one goal for us was safety for me and my baby. I wanted a natural birth, but we discovered that there is a terribly high cesarean rate in the US. The cesarean rate at many of the hospitals in the Philadelphia area alone is higher than 35%, yet the cesarean rate around the world is approximately 10%, partly due to the Midwife Model of Care. A hospital is a good place to be if you are ill or if you need specialized care. After all, it is the place where I have worked for over 15 years. But, pregnancy and birth are natural physiological events. All births do not need to be performed in the hospital. So to my husband and I, the real question about safety was not, “Do we want to have a pleasant birth at home or safe birth in a hospital?” It was “Do we want to birth at home and run the very small risk of an emergency that might, but not necessarily, be handled better in a hospital, or do we wish to give birth in a hospital with its additional stress and the likelihood of an intervention?” It became clear that birthing at home with certified professional midwives was the best choice for us.

We chose to have a home birth with certified professional midwives for other reasons too. Among them were the certified professional midwife’s expertise and specialized training in working outside the hospital setting for birth, the thoroughness of care, the continuity of care, and the postpartum support for both me and my baby. As a health care provider, I make a conscious effort to provide exceptional care for my patients. Therefore, I am in a unique place to evaluate other providers as a health care consumer. I continue to be impressed by the highest professional level of care that I have received from my midwives. Each visit lasted an hour in face to face time of counseling. In each visit, my physical health was addressed in many facets. We went over nutrition, exercise, my psychological health and our preparedness for our baby’s arrival. For continuity, I liked that the same health providers that cared for me during my pregnancy were going to be the same health providers that would be present during the delivery of my child -the same two midwives from beginning to end. There were no shift changes. We saw one of our two midwives at every visit. After the birth of my daughter, the midwives did a home visit every other day and checked in by phone on the other days. They followed us closely for six weeks, providing breastfeeding support and postpartum physical and psychological support. They did well-child visits for my baby. They were available to us on call at any hour. They answered questions every new parent has about her baby. In short, they provided the framework that is so important for the start of a new family.

Of course, we prepared for the upcoming birth in the visits as much as possible. We asked what would happen in the event of an emergency. We saw the emergency equipment that the midwives brought to every birth, and were comforted by the knowledge that our midwives were prepared for transfer to the nearest hospital in case of any problem. In the end, I gave birth in the comfort and safety of my own home, surrounded by people whom I love. In this regard, our daughter was born in a loving place. And I WAS much more comfortable at home. I was not flat on my back, feet in stirrups, attached to catheters, IV’s and monitors. I could walk around until it was time for the actual birth. Lastly, by choosing homebirth, we were immediately part of a larger community. This community consists of other women who have given birth at home. We are urban, educated women, as are our families. We are lawyers, physicians, teachers, engineers and artists. We want the very best for our babies and our families and in larger numbers each year, we are choosing certified professional midwives in our communities as our care providers for planned homebirths.


Nancy said...

Wonderful post, Madhavi! I love your thoughts on home birth. I certainly hope your words make an impact.

r. seligman said...


I am so proud of you! What a powerful and moving speech.

Radha Gopinath das said...

Thank you so much, for caring about the little ones and being willing to take the time and effort to go and represent all of us so eloquently during this crucial step towards making better births available to families everywhere.