A new law recently signed by Governor Rick Snyder means home birth midwives in Michigan will need to be licensed.
What does this mean for women who want to give birth at home in Michigan?
To help explain, Nicole White, a certified professional midwife (CPM) with Midwives Alliance North America and Emily Dove-Medows a certified nurse-midwife (CNM) who is the president of the Michigan affiliate of the American College of Nurse-Midwives joined Stateside.
And to get a first-hand account of what having a home birth is like in Michigan is Danielle Atkinson, a mother of five, who had three of her babies born at home.
The new law requires CPM's, or home birth midwives, to be licensed in the state of Michigan, which among other things, improves the process of transferring women to a hospital when unexpected complications arise.
"We are the 31st state to have a license for the CPM credential and it allows the CPM to be licensed so that we can interface with the medical community a little bit more streamlined, so that when there are transfers [to the hospital] they can happen smoother and with more continuity," White said.
White and Dove-Medows were both involved in reviewing and crafting the legislation, although it specifically affects home birth midwives, like White. The overwhelming majority of births attended by nurse midwives, like Dove-Medows, take place in the hospital setting, but there are a small number in the state who do offer home birth. Unlike home birth midwives, nurse midwives have been licensed in Michigan for some time.
The main opposition to the bill came from various hospital organizations. According to White, hospitals are, for the most part, opposed to home birth in general, not so much to the specifics of the bill. Dove-Medows said the hospitals' concern comes from a business perspective, as well as a difference in philosophy and safety issues.
Anyone who works in the profession, or has been involved in a birth, knows there's no such thing as a risk-free birth.
"Trouble can strike in any setting," Dove-Medows said. "One of the things that we are trained to do is to assess risk and to assess situations so we know if something is leading towards a situation, our job is to be able to recognize issues that come up, have a discussion with the women and families that we work with about how they want to address it. Remembering that the woman herself has choices about where she wants to have her birth and that we support those choices."
"We are gatekeepers and we hold the safety of the women and the children that we work with," she added. "We will work quickly if we need to, just as we do in the hospital, if we feel like we need to get into a situation with more intervention."
According to White, the license gives home birth midwives more access because there are a number of rural and urban areas in Michigan where women don't have access to good maternity care. The hope is that more midwives will be able to get licensed in the state and can help fill those gaps in coverage.
"Midwives, regardless of setting, are the answer to our maternal and infant mortality crisis that we have, not only in the United States, but worldwide," White said.
There are midwives who are handling these births, both in and out of the hospital, but what about the women who going through the process themselves?
Danielle Atkinson has had three completely different experiences through the five births she has gone through. Her first child was born in a hospital and while everyone emerged healthy and happy, Atkinson said the experience didn't meet her expectations.
For the second baby, she moved to the Alternative Birth Care Unit at Providence Hospital in Southfield. It's a birth center within a hospital, run by midwives and allowed her to have a birth experience that was more what she wanted.
For the next three children, they were all born at home.
"It was wonderful," she said. "My mom was able to be at every birth with me and when we saw the first signs of labor and we were able to prepare my bed, and my mom was helping me and get everything ready and know that the room that I was going to have a baby [in] was the room that I was going to stay in and I wouldn't have to rush or worry about being discharged or anything. Or worry about when my children could come and see the baby. It was really great to be in my own space."
Atkinson said whenever she tells people that she gave birth to three babies at home, not everyone is comfortable with it.
"Most people when you say you had a home birth, they [say] 'I would have done that if ...' and so, you want to tell people it's not for everybody. I understand ... we've very much medicalized the experience of birth, so I understand people's reservations but ... it was really great for me and it was great to have the choice and I think people really understand and appreciate choice and options when you're in the most intimate and vulnerable position [you'll be in] in your life."