A woman may choose to give birth in a hospital, at a birth center (usually affiliated with and located near a hospital), or at home. There are also options in terms of who attends a birth: doctor, midwife, and/or doula.

 

 

Hospitals have been considered the “normal” – if not the only – location in which to give birth in the United States over the last century. In response to highly dangerous birthing conditions in the early twentieth century, birth began to move into the hospital in order to control sanitary conditions and the use of medication. Obstetrics and related medical procedures such as the cesarean section continued to be developed and increasingly used.

An alternative birth location is a birth center, which provides a home-like environment to make mothers and their families more comfortable. They provide all of the resources for the birth itself, as well as pre- and post-natal care. Massachusetts has two birth centers: the North Shore Birth Center and the Cambridge Birth Center. Most birth centers, including those two, are located very close to hospitals to allow for easy transfers in cases of emergency. The cost of giving birth at these centers is generally less than at a hospital. Insurance usually offers coverage for birth center services in Massachusetts; however, this can vary by provider.

 

Home birth takes place in a woman’s residence and is generally attended by a midwife. This option allows women the comfort of their own homes during birth and tends to be significantly less expensive than a hospital birth, although less likely to be covered by insurance.

 

 

The shift of childbirth into the hospital also coincided with an effort to improve the training of physicians, who thus became the primary birth attendants. However, the increasing use of medical interventions and rigid hospital procedures has caused a push for a more balanced perspective on birthing options. This has led to incorporating the benefits of hospitals and technologies, when desired by or necessary for the mother, with the more traditional care of midwives.

 

Midwife-attended births have the same outcomes as births attended by doctors, if not better (some studies show lower incidence of medical intervention and lower infant mortality rates) [2]. Midwives in Massachusetts can range in certification from Direct-Entry Midwife (DEM) to Certified Professional Midwife (CPM) or Certified Nurse-Midwife (CNM). DEMs receive education from self-study, apprenticeship, a midwifery school, or other program (not nursing); they operate legally in MA without a license. CPMs have been certified by the North American Registry of Midwives. CNMs additionally have a degree in nursing, have graduated from an accredited graduate-level education program, and have passed a certification exam. Most midwives (not CNMs, due to licensing regulations) can attend homebirths in MA. Learn more about midwives from the Massachusetts Midwives Alliance.

 

Doulas provide emotional, physical, and informational support to a woman throughout her pregnancy and birth. They can attend births in any location and supplement (not replace) the services of an attending midwife or doctor. Research has shown that when a doula supports a mother, there is less need for medical interventions and babies are healthier [3]. While doulas are not covered by insurance, they often offer sliding scales to help all women afford their extra personal care.

 

 

On a national level, the American Medical Association (AMA) and insurance companies hold much power in the realm of birthing options. The AMA made a statement in 2008 against home delivery, despite evidence that home births provide an excellent choice for low risk pregnancies. Malpractice insurance rates continue to rise, which has made it much harder to practice midwifery, run a birth center, or even be licensed as an obstetrician. In 2008, the North Shore Birth Center in Beverly nearly closed due to the rise in cost of malpractice insurance.

 

In Massachusetts, midwives are allowed to practice as DEMs without legal recognition or regulation, and they currently provide services across the state. The Massachusetts Coalition for Midwifery supports An Act Relative to a Board of Midwifery, which would set statewide standards for the practice of midwifery for CNMs, CPMs, and Certified Midwives (CMs). Certified midwives would have the same training and follow the same standards as CNMs, but without a nursing degree.

 

The United States has one of the worst infant mortality rates among developed nations. In particular, the rate for African-Americans is twice the national average. In 2007, the infant mortality rate in Massachusetts was lower than the national average: 4.9 infant deaths per 1,000 live births compared to a national rate of 6.37 [1,4]. However, Massachusetts shows a great disparity among infant mortality rates by race/ethnicity: 3.9 for Whites, 7.4 for Hispanics, 3.1 for Asians, and 10.2 for Blacks [1].

 

While Massachusetts has a lower infant mortality rate than the nation, we have much work to do in order to reduce the health disparities that exist in our state. We must improve the quality of services provided to pregnant women, including access to the information required to choose the best birthing location, attendants, and medical procedures. NARAL Pro-Choice Massachusetts believes that all women deserve equal access to quality care to ensure that they have healthy children.