In California, midwives everywhere are doing home births “under the table.” Whether they’ve been certified or trained on the job by another midwife, these women are practicing medicine without the supervision of a physician, which California law requires.

Why don’t they get physician supervision? Because if a physician were to oversee a home birth with a midwife, they would lose their malpractice insurance, even though the doctor doesn’t have to be at the birth; he or she merely needs to sign off on paperwork and write prescriptions.

Family practitioner Connie Basch, who recently closed her Humboldt County practice to take a job in Vancouver, Wash., provided care parallel to that done by midwives for patients planning home births, but legally could not communicate about the patients with the midwives who were going to do the births. Three years ago when she checked with her malpractice insurance provider to see if she could provide backup for midwives, the answer came back no.

People like Jenny Silverstein and other members of the California Association of Midwives have been lobbying in Sacramento to remove physician supervision as a requirement to practice midwifery, but to no avail so far.

Silverstein said, “There’s a requirement for midwives to have physician supervision. Midwives are treated like any midlevel practitioner, like a nurse midwife or physician’s assistant.” Silverstein, a Humboldt County resident, is a social worker and the secretary and newsletter editor for CAM.

“It’s really hard to get doctors to verbally admit that they support it because there are huge consequences for them.”

Silverstein said she feels it has a lot to do with economics. “There are strong connections between the California medical system and the malpractice insurance companies.”

Why would midwives risk so much to do home births? They could help with hospital births as a nurse midwife or a doula (birthing assistant).

Silverstein said, “Every woman deserves to give birth in the setting of her choosing with the provider of her choosing. For a woman to feel comfortable and feel like she’s being heard by her providers and genuinely supported by them, it has a huge impact on labor, the postpartum time and how she moves into mothering and relates to her baby.”

A midwife in this area who preferred to stay anonymous, for safety reasons, went through an intensive training school for midwifery in another country. She then traveled around developing nations birthing babies. After two years, she had birthed more than 250 babies, including many sets of twins and breech babies, she said.

“Once I started attending births and seeing the power and the magic behind what it is, there’s so much power and magic behind every baby that has been formed. It’s such a beautiful thing to be a part of, that’s what captures my heart,” said the midwife.

She said she sees the primary difference between midwives and hospitals as one of mentality. “Midwives in general usually approach birth as a natural process that women are created to do. The way I see it, it’s normal until proven otherwise. I think a lot of the other medical institutions carry the belief that pregnancy and childbirth is a medical emergency until proven normal – so the approach is totally different.”

Diana Nunesmizer has two children who were both born at home with the help of midwives. She’s also a doula and has assisted with hospital births for 11 years. Nunesmizer said she became interested in birthing when her sister had a baby in a hospital and she felt that it wasn’t set up for her to succeed.

“When you treat it like birth is normal, mothers do great. When you treat it like an emergency and a train wreck, it becomes an emergency and a train wreck, generally. (But) I’m not so naïve to think that problems don’t arise with midwives,” said Nunesmizer.

“(Birth is) a time for women to fully access their power.” Nunesmizer said her home was a better place for that. After Nunesmizer had her babies, she was at home and in her bed, and her friends were there feeding her soup and doing laundry.

Tana Dittmer is labor and delivery nurse at Mad River Birthing Center.

“I’ve taken care of people when home birth doesn’t go as planned and they end up in the hospital,” she said. While Dittmer said she has no firsthand experience with home birth, she is supportive of it.

“Birth is inherently a normal process and the home birth midwives that I have known are very competent. I support home birth for low-risk people. People usually choose home birth because they want a really natural, normal, spiritual experience, and they feel more comfortable in their homes doing that. The whole goal is a healthy mom and a healthy baby,” said Dittmer.

Basch said she is generally supportive of home birth and gives her clients information about home birth if asked. “Our patients are adults and can make their own choices,” said Basch. She said she doesn’t recommend home birth in remote rural areas because in the end, no matter how healthy the mother is or how much planning takes place before the birth, something can always go wrong and the woman could need to be transferred to a hospital.

Basch’s concern lies in that the midwife community doesn’t have a reliable system of peer review. “It was a move for the better to have certified midwives. The peer review is nonbinding in that community.”

As an example, Basch said, if a surgeon at a hospital had numerous complications, there would be a review and they would eventually be told that they couldn’t do certain procedures. In the midwifery community, a midwife can practice and push the boundaries of safety without many consequences. “If they had physician backup, the physicians would have some authority to regulate the midwives.”

“Home birth is pretty much as safe as hospital birth for low-risk women. The problem is I’ve seen all the crazy rare things where I would have been out of luck had I not had the resources available in the hospital,” said Basch.

In her practice, she gave women a consent form to sign if they planned to have a home birth. The form read: “Studies show that a carefully selected low-risk group of women who are attended by Certified Professional Midwives have excellent outcomes: an article in the British Medical Journal in 2005 followed 5,400 women who expected to deliver at home in North America in 2000 and it showed only 12% of women transferring to hospital for delivery. The total perinatal mortality (loss of babies) was 1.7/1000, comparable to hospital statistics seen for a similar low-risk group of women, with a lower risk of cesarean section and other interventions.” At the end, the form stated that the practice does not recommend or back up home births.

Silverstein looks to other countries that have a lower maternal and infant mortality rate than the United States. There are 40 of them, according to CAM.

“They have a tier system where the lowest risk births are taken care of by midwives, but if people become high risk for any reason, they go to being seen by doctors in a collaborative setting. That’s what we’d like to see in this country,” said Silverstein. “What happens in California right now is that every midwife has some sort of unofficial collaboration with a doctor because you have to, but it can never be on paper. Everyone has to be very careful how you speak about it, even to each other.”

“The truth is, these days birth is becoming more and more technological. We have a 30 percent Caesarian rate, which is appalling — double what the World Health Organization considers necessary. Women are being induced earlier in their pregnancy. We are in a trend right now toward more intervention,” said Silverstein. She said the intervention can have an impact on babies.

“There’s a lot of evidence that says after being born, the best thing (for babies) is to be put on their mother’s chest and not interfered with. It happens to a certain degree, locally it does happen, but if someone has a Caesarean, that doesn’t happen.” Silverstein said the baby is more aware during the first few hours after being born than it will be for days, and that the hours just after birth are the best time for the baby to bond with the mother and learn to breast-feed.

“There are a lot of woman who are happy with hospital births,” said Silverstein. “They expect that kind of care and they want it. The idea behind the midwifery movement is that women get to have the kind of care they want and need.”

The previously mentioned anonymous midwife said, “I think there needs to be a safe option for birth outside of the hospital. I’m not anti-hospital. I’ve seen really beautiful sacred births happen at the local hospitals.” What she does is illegal and she could possibly go to jail for it, she said.

“Some people feel more comfortable in their own home, with their own smells and germs and stuff. They perform better in that comfortable environment. Home birth is for normal birth, for low-risk women. That’s a criteria that as a midwife we go by. So 95 percent of the time everything is normal or natural, and there’s no need for intervention, so then a home becomes a really wonderful place for a baby to come into the world.”

Midwives work in teams of two, and when a pregnant woman signs up with a midwife, the midwives do all the prenatal care, stay with the woman through the labor and provide postpartum care in the home.

Renee Miller had her baby at home in a rented birthing tub. She was in labor for an hour and a half. “I feel like things went fast at home. I was a healthy candidate and had parallel care and a backup plan.”

Miller recalls that the best thing was that when it was all over, she held her baby and the midwives tucked them into bed. The shades were drawn and she was already home. “I got the experience I wanted, not something that was forced upon me. It was intense, it was hard, but it was on my turf, in my territory.”

The cost for having a home birth is around $3,000 dollars. That price includes any equipment the midwives use, and the fee is usually split between two midwives.

“It feels like a really positive thing, being able to serve people in their homes, being able to get to know them before their birth in a really intimate way,” said the anonymous midwife.