Do any Dopers know if there are any legal barriers in your jurisdiction to a woman giving birth at home with a midwife when she has had a previous c-section?
Not looking for a debate on this, just want to know if other countries/states regulate this in any way.
I think you are less likely to get a law, and more likely to get a professional standard that would be violated, resulting in 1) the provider being liable for anything that went wrong and 2) the provider losing their license if anyone found out. Such a thing might be characterized as “illegal” by a provider, and even if not strictly true, not a totally inaccurate description.
There actually is a law which governs this in Ireland, which is why I’m asking, but I’d be interested to hear about other countries’ professional standards too.
I’m not sure. I know someone who gave birth at a birthing center (I don’t think it was quite her home) with a midwife after having a C-section with her first. Considering her husband is in the military, I am guessing she did get some sort of approval for that.
No legal restrictions in England (not sure about the rest of the UK, it’s a semi-devolved area). The usual interpretation is that the NHS is mandated to provide care in childbirth, but that doesn’t necessarily imply that this care has to be in your own home. So, arguably, if there were potential problems with the birth the woman might be told she’d have to come to hospital to be seen. As far as I know this has yet to be tested legally, which it seems would have to be a judicial review of the local health authority’s decision to insist on hospital care. There’s no legal way to compel a mentally competent adult woman to give birth in hospital whatever the circumstance. (Short of extraordinary court proceedings, such as you’d get over similar cases of extreme refusals of treatment).
The general principle, though, is that the woman needs to be supported in her birth choices as far as possible. Interestingly, although a bit of a tangent, it seems that unassisted births, even planned ones, are perfectly legal here so long as no unqualified person intends to act as midwife, but is there simply as birth partner.
In the state of Maryland there is no such law, or wasn’t just a few years ago. There are however a number of hospitals and doctors that will not allow or do not help for a VBAC. My ex went through this, she was told she needed a c-section for our first even though she didn’t. The hospital we went to the first time would not allow a VBAC so we had to find another one for our second child. We also had a few doctors that wouldn’t perform a VBAC. We ended up going with a midwife as they dealt with these things more often.
When looking into this the reason given is because they say there’s a higher chance of a uterine rupture. However, we found that there isn’t any significantly higher chance of that with a VBAC.
ETA, forgot to add that yes, here in Maryland you can do a home birth after a c-section, though a lot of doctors will try and tell you not to, midwifes will help.
I cannot imagine any law forbidding a woman to give birth the way she wants, in the place she wants.
Maybe you’re asking whether or not the insurance will cover it?
Do you mean a certified/licensed nurse midwife? Or do you mean a non-professional, unlicensed “doula?”
There’s a big difference.
Also - regarding insurance, at the major (national) insurer where I have worked for 17 years, we include a specific exclusion for births planned in the home, regardless of who is present. May not be the case for all ins. cos. though.
I can ask my friend the CNM about IL (and probably Canada - she is in the process of being relicensed there).
I’m not aware of any legal restrictions, but ethical restrictions? You bet.
Let’s just say that it’s not a good idea, and I personally wouldn’t have considered a home birth, before or after a c-section, if I’d had kids, because too many things can go wrong. Now, if the baby just plain old came that fast, that’s another story.
My biggest concerns would be shoulder dystocia and postpartum hemorrhage, either of which can be fatal to both mother and baby, and usually not predictable either.
This is what my friend says (she is licensed in IL and before that was a labor & delivery nurse and had short-term gigs in a number of other states):
“Off the top of my head, there is nothing specifically illegal about VBAC at home. However, it is illegal in some states for a midwife who is not a CNM (certified nurse midwife) to do any home births. The midwifery scope of practice (heavily influenced by ACOG, the OB doctors group) however, explicitly states VBAC at home is outside the scope of midwifery (even CNMs) practice. Therefore, do it at home at your peril - should you have a bad outcome, 99% of the time, the state will come after your ass and lock you away, strip you of your license, etc.”
Considering there is a much greater chance of uterine rupture VBAC at home is generally a Bad Idea. approx 1 in 200 chance of uterine rupture vs 3 per 1000 without prior c-section. A home birth is also not going to have the option to pursue immediate surgical intervention, you have a good chance of losing both mom and baby.
1 in 200 vs 1 in 333? That’s greater, but I’m not sure I’d call it ‘much greater’. And, do those stats represent likely home-birth candidates? (I mean, women with complications from the surgery or other high risks for rupture probably wouldn’t opt for home delivery, right?)
screwed up my conversion
.47% for VBAC vs .03% for no prior c-section.
Any chance you could cite specific ones, if you’re aware of them? As I said, I’m not looking for a debate on this, I’m trying to find out how it is actually dealt with in the laws - or professional regulations - of different jurisdictions.
Thanks for those who have provided examples so far.
Although off-topic, studies have shown that for low-risk pregnancies, home-birthing with the assistance of a midwife appears to be very safe as compared to hospital births:
http://boards.straightdope.com/sdmb/showpost.php?p=15305015&postcount=5
The Code of Ethics For Nurse-Midwives might be a place to start. Maybe a CNM can chime in as to what force of law the Code of Ethics have. The main effect might be to demonstrate what constitutes negligence in a civil suit, I’m not sure. (the reason I’m not sure is that they aren’t incorporated in the Rules of Unprofessional Conduct for Midwives in my state)
note: not all states require midwives to be CNMs. However more states permit CNMs than permit direct-entry midwives.
Anyway, from those rules, it seems that in certain situations - such as if the CNM believes a woman does not comprehend and take responsibility for the risks of a homebirth in their particular situation - it would be unethical to attend the birth.
Moreover, in my state, a licensed midwife must work in collaboration with a licensed physician, who must agree to an emergency care plan. See Rules for Midwives (the Rules for Licensed Professionals in general and the Rules for Health Professionals also apply) in New York State. If no physician will agree to the emergency plan, that seems to violate the rules of the midwife’s license for her to attend the birth, as beyond the scope of her practice.
As far as I know, VBAC is not illegal at home in Texas.
Whether it is a good idea or not… Well…
The American Academy of Pediatrics (AAP), which agrees with American College of Obstetricians and Gynecologists (ACOG), has issued a new policy statement just last month on home birth.
That statement can be found here: http://pediatrics.aappublications.org/content/early/2013/04/24/peds.2013-0575 Click “Full Text PDF” to read it.
Both organizations agree that a hospital or birthing center is the safest place to give birth. The statement reports that “planned home birth in the United States appears to be associated with a two- to threefold in-crease in neonatal mortality or an absolute risk increase of approximately 1 neonatal death per 1000 nonanomalous live births.”
The statement repeats twice that they respect the right of women to make and informed decision about home birth but recommends that the birth not be attended by “lay midwives or other midwives who are not certified by the American Midwifery Certification Board”, so no doulas or non-brand name certifications.
The AAP statement does not address VBAC (because it focuses on the infant), but ACOG considers VBAC an “absolute contraindiciation” to home or birth center birth.
ACOG’s statement on VBAC is that even after 2 previous low transverse cesarean sections, one could have a trial of labor, but only in a hospital setting. The risk of rupture is between 0.5% and 0.9%, but if it occurs, it is a full blown emergency situation with a likely devastating outcome.
So, illegal? No.
A poor choice? Yes.
Thanks Hello Again. I suppose that triggers a further question, are physicians barred (under legal or professional requirements) from agreeing to a plan that includes HBAC? I know many would refuse to agree to the plan even in the absence of such a requirement, of course.
There is no midwife nor nurse midwife it would even consider you after a c-section in Tennessee. It is absolutely illegal here. The only way you would accomplish a home birth in Tennessee is if you waited until the very last minute and just gave birth and then called the ambulance.