A new study by the Utah Department of Health shows that out-of-hospital births doubled from 1990 to 2012, with 2,595 children being born at home and 1,098 at unlicensed birthing centers between 2010 and 2012.
Holly Richardson with the Utah Midwives Organization said women have increasingly chosen non-hospitalized births for financial reasons and because they want reduced medical interventions in the birth process.
“The number of interventions and subsequent potential complications from those interventions are decreased significantly,” Richardson said.
Richardson said along with these reasons, midwifery also saw a spike in Utah after the passing of the 2005 Midwife Licensure Act.
“When midwives were legalized to practice and could choose to become licensed or continue to practice unlicensed, I think that coverage of that legal ability to choose a midwife let people know that that was a viable option for them where they probably wouldn’t have seen it before,” Richardson said.
State law allows women to choose the circumstances of their birthing experience, including whether to choose a licensed or unlicensed prenatal and delivery provider. However, Nan Streeter, director of the Maternal and Child Health Bureau at the Utah Department of Health, urges women to make decisions based on providers’ credentials and experience.
“I think a lot of times the public isn’t necessarily aware of the differences between a licensed and an unlicensed midwife or that there are even different types of midwives,” Streeter said.
Midwives licensed through the Utah Division of Occupational and Professional Licensing are required to pass a national exam, as well as complete academic and clinical trainings including a pharmacology class. They must be CPR certified and have certification in neonatal-resuscitation. Once certified, midwives can carry and use some medical equipment such as oxygen, and administer limited medications.
The study found that infant mortality in a hospital setting is 1 death per 1,000, while out-of-hospital deaths were 2.3 per 1,000.
Of four specific cases reviewed for the study, half were determined to be preventable if the care providers would have had proper training and equipment.
“When we look at the poor outcomes they are related mainly to homebirths, and the majority of homebirths are overseen by midwives who are not necessarily licensed,” Streeter said.
Richardson calls this data an outlier, referring to other studies.
“We are concerned about that. We want to do some further research and hope that the Department of Health will partner in doing additional research to find out is this an anomaly? Is it because the sample size is so small? But if it’s a problem, we want to know about the problem; we want to be able to address it and to fix it,” Richardson said.
Utah is one of the top ten states in terms of out-of-hospital births, along with others such as Washington, Oregon, Idaho and Nevada.