Home Births and the ACNM
by Marion McCartney
As Director of Professional Services at the American College of Nurse-Midwives (ACNM) and because of my history as a home birth CNM, I am frequently asked to comment on ACNM's position on home births. In a single day, it is not unusual to find myself explaining that CNMs/CMs do more than just home births to one caller; defending the right of women to choose home births to another; and helping a home birth midwife create a practice that safely moves a woman to whatever level of care she needs. At the CIMS meeting, similar conversations took place. The following ACNM Position Statement on Practice Settings was developed in 1980 (and updated in 1997): Every family has a right to a safe, satisfying childbirth experience, with respect for cultural variations, human dignity and the rights as consumers to freedom of choice and self determination. The certified nurse-midwife and certified midwife may practice in a variety of settings including hospital, home and birth center. In any practice setting, provision for the safety of mother and baby is of primary concern.
Long before the time of position statements and fact sheets Mary Breckinridge began the Frontier Nursing Service home birth practice and brought nurse-midwifery to the foothills of Kentucky in the 1920s. Since then, CNMs/CMs have been providing home birth services to women in the US. Currently CNMs attend approximately 3,000 births at home, 5,500 births in freestanding birth centers and 289,000 hospital births per year. These numbers are a direct reflection of the cultural choices American women are currently making.
Written materials to assist members who attend births at home are the ACNM Handbook on Home Birth (1997) and The Journal of Nurse-Midwifery Home Study Program on Home Birth (1995). Professional liability insurance through ACNM Insurance Services is available to members attending homebirths in all fifty states. The Home Birth Committee made up of ACNM members with experience and interest in this field provides peer support, continuing education and guidelines for practice.
ACNM will continue to address the challenges of homebirth practices which include health plans which refuse to reimburse for birth at home, physicians who will not collaborate, and the expense of professional liability insurance for small home birth services. The CNMs/CMs who provide home births, birth center and hospital births, carry on a long tradition of providing safe, evidence based, choices to women and their families.