July 16, 2014
Volume 16, Issue 15
Midwifery Today E-News
“Birth Centers or Homebirth?”
Print Page

Welcome to Midwifery Today E-News !

Midwifery Today Online Store

MT online store

Enjoy the birth stories of three couples

Just $18, this 42-minute DVD will show you various ways of giving birth, including waterbirth and squatting. The couples also discuss why they decided that homebirth was the best option for them. The audio in Homebirth Stories is in Hebrew, the subtitles are in English. To order

This issue of Midwifery Today E-News is brought to you by:

Look below for more info.

In This Week’s Issue

AU conferenceLearn about the Anthropology of Reproduction with Robbie Davis-Floyd

Attend this all-day workshop to get an overview of the exciting sub-discipline of the anthropology of reproduction from its early beginnings to its latest findings. The class will concentrate on anthropological studies in four major areas: childbirth, midwifery, the new reproductive technologies, and the politics of reproduction. Robbie’s goal is to provide a stimulating overview of these anthropological sub-disciplines for midwives and others who want to know what the social scientists are up to, and to accompany that overview with an extensive annotated bibliography that will provide a helpful template for further exploration and research.

Learn more about the Byron Bay, Australia, conference.

Quote of the Week

If women lose the right to say where and how they birth their children, then they will have lost something that’s as dear to life as breathing.

Ami McKay, author of The Birth House

Are you enjoying your copy of Midwifery Today E-News? Then show your support and get more content by subscribing to our quarterly print magazine, Midwifery Today. Subscribe here.

The Art of Midwifery

When giving birth, all mammals have strategies to avoid feeling observed—privacy is one of their basic needs. At the same time, all mammals need to feel secure. For example, in a wild environment, a female cannot give birth as long as a predator is around. Physiologists easily explain that in such a situation the female releases hormones of the adrenaline family. This activation of the fight-or-flight system blocks the release of oxytocin, the key hormone in childbirth—the birth is postponed until the time when the female can feel secure. We are in a position to claim that today the priority is to mammalianize childbirth.

Michel Odent
Excerpted from “Dispelling Disempowering Birth Vocabulary,” in Birth Wisdom from Michel Odent, a Midwifery Today e-book

ALL BIRTH PRACTITIONERS: The techniques you’ve perfected over months and years of practice are valuable lessons for others to learn. Share them with E-News readers by sending them to mtensubmit@midwiferytoday.com.

Send submissions, inquiries, and responses to newsletter items to: mtensubmit@midwiferytoday.com.

RSS Feed Subscribe to the Web Updates RSS feed to stay on top of what’s new or highlighted on the Midwifery Today website. Be alerted when conference programs go online, new articles are posted and more.

Editor’s Corner


I would love to see homebirth make a comeback in our culture. I loved my homebirths—they were the best experiences in my whole life. I like to say that homebirth provides a non-drug-induced high! A good birth, no matter where it takes place, lets mom start mothering on a solid foundation, and we all know that happy mothers make for happier families! An optimal birth may be the best thing we can do for the health of our society, and since I am a believer in the sanctity of homebirth, I think more homebirths would equal a healthier society.

As midwife Carla Hartley says, “More babies prefer homebirth.” But!…we have to hold to a standard that is outside of medical protocols and really think about what is safe in birth care. We are letting women down when we routinely give over care at 41–42 weeks because our license is beholden to a particular protocol. Maybe the mom has a long cycle and isn’t really due; this is where using evidence is helpful because our protocols are often not based on evidence. We cannot raise the number of homebirths if we are transferring the women who already want a homebirth to hospitals because they carry their babies longer than 41 weeks (most first-time moms usually do go past 41 weeks!).

Homebirth can be the gold standard of birth care when we midwives use wisdom based on evidence while honoring a mother’s choices. We need to find ways to change our direction—the regulations ruling us are effectively taking mothers’ choices away. How can we increase the number of homebirths in California when midwives cannot serve in twin, breech or VBAC births? There are really no options for these moms in California if midwives are not allowed to serve them. Homebirth can only increase if we change some of these protocols. Perhaps it is time to work harder on these political issues so homebirth numbers can really rise.

Home really is the best place for birth in most cases. Let us work to improve the numbers!

— Jan Tritten, mother of Midwifery Today

Jan Tritten is the founder, editor-in-chief and mother of Midwifery Today magazine. She became a midwife in 1977 after the amazing homebirth of her second daughter. Her mission is to make loving midwifery care the norm for birthing women and their babies throughout the world. Meet Jan at our conferences around the world, or join her online, as she works to transform birth practices around the world.

Midwifery Today on Facebook
Midwifery Education: Caring and Sharing
Midwifery Today on Twitter

Please support our advertisers
The Surgical Superstore

eSutures is a discount distributor of brand name suture and surgical supplies at below market prices in quantities YOU choose. We stock over 1 million items, including Ethicon, Covidien and Dermabond, all available INDIVIDUALLY. Why pay for more than you need? Visit our website or call 888-416-2409 for pricing and availability today.

Featured Article

The National Birth Center Study II: Research Confirms Low Cesarean Rates and Health Care Costs at Birth Centers

As health care costs and the rate of cesarean births for expecting mothers have escalated over the past two decades, a new study published in the January/February issue of the Journal of Midwifery & Women’s Health, the peer-reviewed journal of the American College of Nurse-Midwives, shows that clients of midwife-led birth centers pay less in health care costs and are less likely to have cesarean births compared to women in the same risk category who give birth at hospitals. Conducted by the American Association of Birth Centers (AABC) and authored by Susan Rutledge Stapleton, CNM, DNP, Cara Osborne, CNM, SD, and Jessica Illuzzi, MD, MS, “Outcomes of Care in Birth Centers: Demonstration of a Durable Model”—referred to as the National Birth Center Study II (NBCS II)—explores outcomes associated with more than 15,500 births to clients of midwife-led birth centers. That’s the largest study of midwifery care outcomes since NBCS II’s 1989 predecessor, the first National Birth Center Study published in the New England Journal of Medicine.

NBCS II reinforces longstanding evidence that midwife-led birth centers provide safe and effective health care for women during pregnancy, labor and birth.

“This study is momentous for the midwifery profession and the women and newborns we serve,” said ACNM President Holly Powell Kennedy. “As midwives, we are intimately acquainted with the benefits of midwifery care, but current data about the outcomes of midwife-led care is what proves to other health care providers, payers and policymakers that our care is safe and effective.”

The results of NBCS II are overwhelmingly positive. The study monitored and recorded outcomes for 15,574 women who received care in 79 midwife-led birth centers in 33 US states from 2007 through 2010. Eligibility criteria for birth center birth included singleton full-term gestation in vertex presentation with no medical or obstetric risk factors precluding a normal vaginal birth or necessitating interventions such as continuous electronic fetal monitoring or induction of labor. Of the women planning a birth center birth at the onset of labor, 13,030 (84%) successfully gave birth at birth centers while 2544 women (16%) gave birth at a hospital. Results were collected using AABC’s Uniform Data Set, an online data registry developed by AABC with a taskforce of maternity care and research experts.

The study found that fewer than 1 in 16 (6%) of the participants required a cesarean birth compared to nearly 1 in 4 (24%) similarly low-risk women cared for in a hospital setting (Menacker 2005). Only 1.9% of transfers to hospitals were due to emergencies, the rate of fetal and newborn mortality was comparable to those in low-risk hospital care and there were no maternal deaths. NBCS II shows that even women who leave birth centers and are transferred to hospitals to have their babies after labor begins have excellent birth outcomes and significantly lower cesarean rates.

Because payments for care are nearly 50% greater for women who have cesareans versus those who give birth vaginally, study findings suggest that birth centers also decrease direct and indirect costs to the US health care system. Given lower costs in the birth center setting, as well as low rates of cesarean birth, the 15,574 births in this study may have saved more than $30 million in facility costs alone based on Medicare/Medicaid rates, not including further savings in costs of additional providers, anesthesia and newborn care in hospital settings.


  • Menacker, F. 2005. “Trends in Cesarean Rates for First Births and Repeat Cesarean Rates for Low-Risk Women: United States, 1990–2003.” Natl Vital Stat Rep 54:1–9.

Melissa Garvey
Excerpted from “The National Birth Center Study II: Research Confirms Low Cesarean Rates and Health Care Costs at Birth Centers,” Midwifery Today, Issue 106
View table of contents / Order the back issue

Please support our advertisers!
Save on the New Edition of Varney’s Midwifery
Varney's Midwifery book coverThe gold standard for midwives and students is back with Varney’s Midwifery, Fifth Edition. New to this edition are chapters describing the profession of midwifery, reproductive physiology, clinical genetics, and support for women in labor. Interwoven throughout is information on primary care, gynecology, maternity care, and neonatal care. Save 25% when you order online with coupon code VARMT4.

Featured Products

Second Stage Handbook

Buy Midwifery Today Issue 104, on doulas, in PDF format

Good news! Midwifery Today Issue 104, which is all about doulas, is now available to purchase as a PDF. The print edition of this issue has sold out, so we are pleased to be able to offer this valuable information in a downloadable format at Lulu.com. Contributors include Michel Odent, Debra Pascali-Bonaro, Allie Chee, Susun Weed and Sister MorningStar. Order the issue.

Read about First Stage
Download this e-book and you’ll receive a collection of 10 articles taken from past issues of Midwifery Today magazine. Articles include “First Stage: Preparing the Fetus Ejection Reflex” by Michel Odent, “The Times and Tools of Induction” by Sister MorningStar, “Nourishing the Mother” by Anne Frye and “Like Cures Like: Homeopathy for Labor and Birth” by Diane Gregg. Available on Amazon or on Smashwords in a variety of formats.
First Stage e-book cover

Keep track
of the births
you attend

Midwife's Journal
The Midwife’s Journal has room for you to record the essentials of up to 100 vaginal births and 20 cesareans. There’s also a section for addresses and telephone numbers and an appendix of forms and charts. Plus, the one-of-a-kind freestyle index lets you compile statistics or quickly find complicated cases or other significant events. Durable enough to be carried in your birth bag and subjected to the rigors of daily use, this unique organizer is ideal for midwives, physicians, doulas, nurses, and other childbirth professionals. To order

Sick and tired of seeing birth misrepresented in the media?
Laboring Under an Illusion

Then you need Laboring Under an Illusion: Mass Media Childbirth vs. the Real Thing. Explore media-generated myths about childbirth as you watch over 100 video clips chosen by anthropologist Vicki Elson. This DVD is a thought-provoking tour of diverse attitudes and practices, and an enlightening look at how media influences our attitudes toward birth. Get the DVD.

Give the gift of information!
You’ll save $5 per subscription when you order two one-year Midwifery Today subscriptions at the same time. And one of these can be your own renewal or new subscription! Subscribe. Midwifery Today Magazine

What are the appropriate uses of medicinal herbs based on tradition and science?

Botanical Medicine in Midwifery Practice will help you find the answers.

Botanical Medicine in Midwifery PracticeLearn the use of extracts and the differences between standard, alcohol and water based preparations. This book includes a glossary of plant categories and a comprehensive list of herbal resources, products and supplies. The final section provides information about essential herbs for women.

Make sure you know how to use herbs in your practice. Order your copy.

Website Update

Read this article from Midwifery Today magazine, now on our website:

  • In Memory of Marsden Wagner, A Friend to Midwives, 1930–2014

    Excerpt: The world lost a treasure earlier this year, but his passion and kindness will forever remain in our hearts. This tribute contains memories, stories and thoughts about Marsden from some of his midwife friends. “Mardy’s intensity was his strength. He raced to get his last two books out. There were things he wanted to say to the world of moms and midwives before he retired. Born in the USA and The Birth Plan were his last two books. They are as relevant today as when they were first written. He still speaks to moms through those books.” [Jan Tritten]

Promote Your Product or Service Here
advertise in E-News

For as low as $100 per insertion for a text-plus-graphic ad, you can put your birth-related product or service in front of over 20,000 E-News subscribers from around the world. This is a great way to reach midwives, parents, childbirth educators, physicians, nurses, doulas and others interested in safe, natural birth.

Learn more here or contact our Ad Director at ads@midwiferytoday.com.

Birth Q&A

Q: For midwives and doulas who have worked both in birth centers and in homes, which setting for birth do you prefer and why?

— Midwifery Today

A: Home. We have all the same tools in both places, but I move from place to place, not the family in labor. It is their space. The husband isn’t looking for random food/coffee/towels. He knows where to find what he is looking for!

— Courtenay E. Grabowski

A: Home, and even though a birth center is as homelike as possible, it isn’t the mother’s space. It brings a totally different mindset to be invited into the mother’s intimate space; it invites respect for the birth process and encourages the partnership within the birth team.

— Vicki Taylor-Breheim

A: I love homebirths, but there’s one birth unit near me in Scotland where I’m equally happy. The midwives work with good autonomy and have taught me loads about physiological birth. They support me, as a doula, and I am very comfortable in their company. I can go make tea and toast without asking. The mutual trust makes the difference.

— Karen Law

A: There are benefits to both: privacy at home; privacy in birth center if home is full of people. Wherever mom feels secure, cared for and surrounded by only those she trusts is the best place for her to birth.

— Gail Johnson

A: It has been my observation, over the years, that the less interference with birth, the more the mother is able to follow her own inner guide and, therefore, the fewer the complications. In your own home, you are the decision-maker. You don’t like how I’m acting as your midwife? You can ask me to leave, and I am legally obliged to do so. This gives a whole different tone to our interaction than in a birth center or hospital, which I think gives an inherent advantage to mom and family. [A birth center or hospital intrinsically has] more power, and power over the woman giving birth is a problem in childbearing, in my opinion. Birth center and hospital birth can only hope to imitate homebirth in order to obtain the best results—like formula trying to imitate breast milk. That’s why I like the saying, “Homebirth; the standard of care.” I would like to add that the best place of birth is where the mom wants to be. Even while I was writing this, I was thinking of a mom who had some troubles at home who happily birthed in the hospital and stayed for three days. Her teenage daughter came every day after school, sat by mom and did her homework and chatted. The daughter told me once during that time, “I love it here.”

— Marion Toepke McLean

A: My dream is that all the places we birth in will be like home. A woman must be supported to have her baby, where she feels safe. The home, hospital or birth center all must be heavens for motherbaby.

— Robin Lim

A: My heart is in homebirth, but I also work in a busy birth center. Since I’ve had my own babies at home, I see the benefit of not having to get up and go somewhere right after birth. For other moms, though, a birth center offers the privacy they might not get in their home, especially if they share it with many other family members. There are advantages to both, so of course we honor what families are comfortable with.

— Salli Gonzalez

A: Home. I always say that the woman walking out her front door is the first intervention. I want to be in her space and on her terms.

— Lisa Sulffridge

A: I agree with all those describing why home is the gold standard (and it is often most fun for the midwife). For women on Medicaid, homebirth is either not covered or financially nonviable, so a birth center remains the only way to escape the medicalization of childbirth for this population of mothers. Thank goodness for birth centers.

— Dinah Waranch

A: I work as a doula and I have no birthplace preference. No matter where you are, there is a laboring woman who needs lots of support and care, and that is what’s most important to me!

— Melissa Jolly

ed page graphic

You want to be a midwife, but where do you start?

Are you an aspiring midwife who’s looking for the right school? Or maybe you’re trying to decide if midwifery is the path for you. Visit our Education Opportunities page to discover ways to start or continue your education.

Classified Advertising

Pure, Therapeutic Grade Essential Oils. Wholesale discounts, no minimums. Diffuser and starter kit available. Purchase a Wholesale Premium Kit and receive: $10 Amazon gift card, 400+ page Essential Oil Pocket Reference book and diffuser necklace free! puremotherhood@gmail.com or www.heirloomgirl.com

Tell our readers about your business. Just $48/issue ($135 for four) gives you 35 words to promote your products or services. Go here to learn more or write ads@midwiferytoday.com

E-News Subscription Information

Remember to share this newsletter—it’s free. You may forward it to as many friends and colleagues as you wish—just be sure to follow the copyright notice.

Manage your E-News subscription

To subscribe

Just go here and fill out the form:

Change your e-mail address

If you are a current subscriber and you want to change the e-mail address to which the newsletter is delivered, please click the “update subscription preferences” link at the bottom of any mailed issue and then make your changes.

If you are a current subscriber and want to stop receiving the newsletter, please click the “unsubscribe from this list” link at the bottom of any mailed issue and then make your changes.

If you have difficulty, please send a complete description of the problem, including any error messages, to newsletters@midwiferytoday.com.

Learn your subscription status

If you are not receiving your issues, but have subscribed, contact newsletters@midwiferytoday.com with the address you used to subscribe and we will look into it for you.

Learn even more about birth.

Midwifery Today Magazine—mention code 940 when you subscribe.

 1-Year Subscription2-Year Subscription
United States$55$105
All other countries$75$145

E-mail inquiries@midwiferytoday.com or call 800-743-0974 to learn how to order.

Or subscribe online.

How to order our products mentioned in this issue:

Secure online shopping

We accept Visa and MasterCard at the Midwifery Today Storefront.

Order by postal mail

We accept Visa; MasterCard; and check or money order in U.S. funds.

Midwifery Today, Inc.
PO Box 2672
Eugene, OR 97402, USA

Order by phone or fax

We accept Visa and MasterCard.

Phone (U.S. and Canada; orders only):  800-743-0974

Phone (worldwide):  +1-541-344-7438

Fax:  +1-541-344-1422

E-News subscription questions or problems

Editorial submissions, questions or comments for E-News

Editorial for print magazine



For all other matters

All questions and comments submitted to Midwifery Today E-News become the property of Midwifery Today, Inc. They may be used either in full or as an excerpt, and will be archived on the Midwifery Today website.

Midwifery Today E-News is published electronically every other Wednesday. We invite your questions, comments and submissions. We’d love to hear from you. Write to us at: mtensubmit@midwiferytoday.com. Please send submissions in the body of your message and not as attachments.


This publication is presented by Midwifery Today, Inc., for the sole purpose of disseminating general health information for public benefit. The information contained in or provided through this publication is intended for general consumer understanding and education only and is not intended to be, and is not provided as, a substitute for professional medical advice, diagnosis or treatment.

Midwifery Today, Inc., does not assume liability for the use of this information in any jurisdiction or for the contents of any external Internet sites referenced, nor does it endorse any commercial product or service mentioned or advertised in this publication. Always seek the advice of your midwife, physician, nurse or other qualified health care provider before you undergo any treatment or for answers to any questions you may have regarding any medical condition.

Copyright Notice

The content of E-News is copyrighted by Midwifery Today, Inc., and, occasionally, other rights holders. You may forward E-News by e-mail an unlimited number of times, provided you do not alter the content in any way and that you include all applicable notices and disclaimers. You may print a single copy of each issue of E-News for your own personal, noncommercial use only, provided you include all applicable notices and disclaimers. Any other use of the content is strictly prohibited without the prior written permission of Midwifery Today, Inc., and any other applicable rights holders.

© 2014 Midwifery Today, Inc. All Rights Reserved.

Midwifery Today: Each One Teach One!