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    Readers React: Letters on home birth

    Home birth: not all midwives are the same

    I am a certified nurse midwife, certified by the American College of Nurse Midwives (ACNM) and now the American Midwifery Certification Board (AMCB). The recent article by Frank A. Chevrenak, MD, and Amos Grünebaum, MD, [Home birth: the obstetrician’s ethical response, May 2015 Contemporary OB/GYN] gives outcomes of planned home birth based on a generic "midwife" group. In their article they state that 2 of the 3 midwives attending planned home births were not in fact certified by the AMCB. This indicates that the "midwives" they grouped together included those with less education and fewer credentials than a CNM, MSN.

    Although my midwifery career has been primarily in a hospital practice, I have delivered in 2 birth center settings and one home birth practice. The first birth center practice was truly a low-risk population and was directly across the street from a hospital for those sometimes-needed transfers. The second birth center practice (which was also the home birth practice) with which I had experience was not adhering to a truly low-risk population and increased risk clearly was being tolerated, which is why I left that practice after only 4 months. Interestingly both of these practices employed CNMs. The first birth center was well established and had more than 6 midwives on staff at that time, as well as many RNs and a board that regulated the practice. The second practice was owned and operated by one midwife and had no board or regulating entity.

    I guess my point here is that if these folks who did the study on home birth were to weed out the kooks, and look at the outcomes of CNMs only (even though there would still be the outliers like the one I briefly worked for), the stats would look quite different. Just my observation.


    Marilyn R. Smith, CNM, ARNP, MSN


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