Facts about Midwives, Midwifery, and Homebirth

A 1959 court decision (Blant vs. State of Texas) found midwifery not to be the practice of medicine because "childbirth is not a disease or disorder, but a normal function of womanhood."


Texas legislature finds that "(1)a parent has the responsibility and right to give birth where and with whom the parent chooses; (2) childbirth is a natural process of the human body and not a disease; and (3) midwifery has been practiced in this state since the days of the Republic."  (From the Texas Midwifery Act, Occupation Code, Chapter 203.003.  Texas Department of State Health Services.)


A midwife assists only in normal childbirth except in an emergency situation that poses an immediate threat to the life of the mother or newborn.  (TDH, "Responsibilities of the Lay Midwife")


"Midwives in Texas have had the lowest infant mortality rate of any attendant type from 1990 - 2000."  The infant death rates for 1990-2000 never exceeded 3/1,000.  "Births performed by either an MD or a DO have always been at least twice as high as the published rate for midwives."
(Midwifery in Texas: Safety, Regulation and Need
Version 1.0
.  July 2002.  Association of Texas Midwives.)


"Midwives in Texas had lower cesarean rates than all other provider types, with rates typically under 2/1,000. Cesarean rates for both MDs and DOs were consistently higher than 200/1,000 from 1991-2000."  (Midwifery in Texas: Safety, Regulation and Need Version 1.0.  July 2002.  Association of Texas Midwives.)


Educated midwives are trained to identify potential problems and complications and to refer clients to the appropriate health care provider when needed.


For greatest safety, midwives need better medical support and backup from hospitals and doctors.


Care by a midwife costs only about 20% of standard care by a physician and hospital.


The association of Texas Midwives offers Apprentice Training and Certification, Professional Certification, Peer Review, and has published protocols for practice and standards of care.


According to the World Health Organization, a low-risk first pregnancy at home was as safe as a hospital birth.  For a low-risk subsequent pregnancy, a home birth had significantly better results than a hospital birth.  (World Health Organization's Summary of Research on Place of Birth [excerpted from Care in Normal Birth: A Practical Guide Report of a Technical Working Group p. 10-12]


In Sweden, the rate is 3.9 deaths per 1000 population.  In the Swedish study "Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome. Zurich Study Team" BMJ 1996 Nov 23;313(7068):1313-8  by Ackermann-Liebrich U; Voegeli T; Gunter-Witt K; Kunz I; Zullig M; Schindler C; Maurer M., it was found that women in their country who chose homebirth had significantly less medication and fewer interventions.  It was found that there was no difference between homebirth and hospital birth in duration of labor, severe perineal lesions and maternal blood loss.  There was also no difference in birth weight, gestational age, and clinical condition.  APGARS of home birth babies were slightly higher.  It was concluded that healthy low risk women who wish to deliver at home have no increased risk either to themselves or to their babies. (The Center for Unhindered Living: Birth Research.)


The Texas Department of Health's Statistics show that midwives in Texas have a lower infant mortality rate than physicians.  (Texas Midwifery Program, Six Year Report, 1983-1989, Berstein & Bryant, Appendix Vllf, Texas Department of Health taken from Corroborating Citations on the Safety of Homebirth)


Overall, women who have a home birth have a higher rate of satisfaction.  They experience less pain and lower levels of intervention in addition to having more autonomy.  (Homebirth: What are the Issues? by Sara Wickham a version of this article was originally published in Midwifery Today, No. 50, Summer 1999, pp 16-18.)


There are a finite number of emergencies that can occur during a homebirth most of which can be eliminated in advance of labor.  There is usually plenty of time to deal with any complications that arise.  (Homebirth: You're Having Your Baby Where??? Special Delivery, Vol. 15 No.2 Spring 1992. pp. 8)


Other resources:


Is Homebirth for You? 6 Myths About Childbirth Exposed. Editor: Janet Tipton originally published by Friends of Homebirth @1990 by Friends of Homebirth.


Planned Homebirth is Safe for Most Mothers and Babies. Citizens for Midwifery 2004. 


Birth is Not an Illness:  16 Recommendations from the World Health Organization.  Compiled from Care in Normal Birth: report from a technical working group. 


Midwife Attended Births at Home are Statistically Safe.  Association of Texas Midwives.



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