What Do CNMs/CMs Think about Planned Homebirth?

by Eileen Ehudin Beard, CNM, FNP

An interesting study in the December issue of Birth explores American nurse-midwives’ attitudes toward planned homebirth and their impact on a woman’s choice of birth site. The findings suggest that, as a group, nurse-midwives have a “moderately favorable” attitude about planned homebirth and that their education and practice experiences may greatly influence their patients’ maternity care choices.

Factors that positively influenced nurse-midwives’ attitudes were clinical and educational experiences with planned homebirth, exposure to planned homebirth, and younger age. The study also identified barriers that had a negative impact on attitudes toward planned homebirth, including financial and time constraints, inability to access medical consultation, and fear of peer censure.

As health care providers, we sometimes underestimate the influence we have on women. When I was seeing patients at the Baltimore Birth Center, I was acutely aware of how my opinion could influence a patient’s choices. The way I presented out-of-hospital birth to my patients was a big factor in their decisions. Of course, my goal was to educate patients and assist them in the decision-making process. I always wanted women and their families to make the choice that was best for them. But when I read the study in Birth, it made me revisit the issue of the attitudes we have and whether we are objective in the information that we present to women. When I was primarily working at the birth center, I don’t ever remember offering the option of homebirth unless the woman specifically requested information. Was I doing my patients and their families a disservice?

It’s worth noting that many certified nurse-midwives (CNMs) and certified midwives (CMs) have a strongly favorable attitude toward planned homebirth. According to CDC data, CNMs/CMs attended nearly 4,000 homebirths in 2006. But as a group, we have some work to do to decrease the barriers to homebirth practice and to seriously examine our personal views. If we are not comfortable with out-of-hospital birth, our patients will not view it as a viable option. And true informed choice cannot happen if a woman is not aware of all her options.