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Imagine, leaving a 23-hour labor and birth, after mom birthed the baby in the family’s living room right alongside her wife. All night she labored, with the lights low, in her home, in the hands of a safe provider, where she could grab snacks filled with protein or Gatorade from her own fridge. In the dawn of the day before her son was born she walks with her wife in their backyard, sits in their garden, and the baby descends. Baby was born as soon as the sun was high enough to light the entire house up. You tuck the birthing mom into her own comfortable king-size bed, you make sure the baby is breastfeeding well before you pack up to leave yourself. You drive home, knowing this mom had a respectful birth, is comforted in her own home, and safe. You plan to come back in 30 hours for her first, in-home postpartum visit. She can call you at any time, because you have created a trusting, culturally responsive relationship with her and you provide the quality gold standard of maternity care.
That was me, leaving a home birth in 2015 as a certified professional midwife in Texas. Birth can look like this. It is safe, often culturally-congruent, simple and noninvasive. With COVID-19 scaring clientele away from the hospital, home-birth midwives in Colorado are seeing an increase in the desire for home birth. In fact, midwives across the country are seeing a surge in home birth. But COVID-19 isn’t the only reason clients are turning to home-birth midwives. While the country is in the midst of civil unrest and the impact of racism is on full display we are seeing more and more women of color turning to midwives outside of the hospital system to prevent experiencing medical racism and, at worst, dying of preventable deaths due to pregnancy or childbirth complications.
Disparities in the perinatal period are fueled by racism. We know that Black American women receive poorer quality care than white women. Examples of this are denial of care when a woman is seeking help, lack of response to women enduring pain, or not being treated with dignity. Women and families are often left to advocate diligently in the delivery room due to the general knowledge that women of color are dying more often in labor and birth from preventable causes. Black women, for example, are four times more likely to die from pregnancy-related causes.
We are seeing families make the best decisions for themselves and protecting their vitality by choosing certified professional midwives. Home birth may not be the best option for everyone, but we can still learn a great deal about the effectiveness and unique qualities that the model of midwifery care offers for families. The longer appointment times, the ability to choose your provider, thorough prenatal and childbirth education, a home visiting model, lactation support integrated into every provider’s scope of practice, the culturally sensitive care, and a person-centered approach are all pieces our current maternity care system does not prioritize. We have a far pathway to improving birth outcomes in Colorado, but, more specifically, for women and families of color. While COVID-19 may have shed light on the importance of midwifery care and home birth, we should consider it the gold standard.
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Not everyone has access to midwives and home birth, which is why we need a push for Medicaid reimbursement for certified professional midwives (CPMs) in the state of Colorado, and integration of midwifery care in our hospital system, including the option for co-managed care of both hospital providers and home birth midwives.
In the 2021 legislative session, changes to state law could be made in regards to the scope of practice for midwives, and there will be a chance for advocates to expand the scope of midwifery, for example by enacting Medicaid reimbursements. At a time like this, we must protect our midwives and their ability to maintain the safest option for physiological birth and culturally sensitive care for all families, but particularly families of color and those who experience perinatal racial disparities.
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