This blog post is featured from a past "Ask Oriana" submission question, submitted for the Wildwood Window newsletter. You can submit your own questions here.
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Is home birth legal in North Carolina?
Short answer? YES.
It is legal in ALL FIFTY STATES to give birth at home. As it should be. As I hope it always is. You can birth however, and wherever, with whomever you choose.
Now there are some grey areas to discuss with this question.
The birthing person or family, can give birth however they please. They can birth unassisted if they so choose, or hire a midwife. In North Carolina, the laws are a little tricky to understand. There are different kinds of midwives. The main two categories are CPM's- certified professional midwives, and CNM's- certified nurse midwifes.
CNM's practice midwifery legally in North Carolina. A CNM completes nursing school in addition to schooling and certifying as a midwife.
CPM's practice midwifery "underground" in North Carolina. They do not attend nursing school. Most states recognize and honor the work of CPM's or CM's, but North Carolina has not quite caught up to embrace the midwifery standards.
There are also traditional midwives, who may use the term midwife or practice under a safer name like birthkeeper or doula. A doula is not a midwife. A birthkeeper is a broad term to cover many birth offerings. These terms are not governed like CPM and CNM are.
Midwifery in general, is just as professional and just as safe as care with an OB, and often times is considered safer because it takes into account the spiritual and emotional wellbeing with every action and treatment plan. Where OB care typically only treats the physical or the scientifical.
That being said, midwives are humans. Subject to the same bias and personality flaws as any one else. No position is above the flaws of humanity.
The reason you need to understand these things, is because if you are planning a home birth, you need to consider who, if anyone, you plan to hire to attend to you during your pregnancy, during your birth, and into your postpartum. Because of the laws in NC, it can be difficult to find a midwife to attend your birth. ALL of our midwives book fully and quickly. Some areas have more choices than others. There are many student midwives and people fighting to change some of the laws for the better, so my hope is that these options will continue to grow.
CNM's and CPM's as far as their titles go, are for the most part, highly trained and recommended despite the restrictions paper puts on them. I personally, would feel comfortable birthing with either if I found the right person for my team. It is important to ask good questions and ensure that you trust the person and the training of the person you hire. Learn their limitations, their methods of accountability and transparency, their practice philosophies and their experince levels.
With a CNM you are hiring someone above board, which means you may be able to use your insurance. You may have a continuation of care should you need to transfer your birthing plan to a hospital or medical facility.
With a CPM, you may not have those luxuries but may have greater flexibility within your criteria of care.
A midwife, of any kind, chooses her limits and boundaries, what she can do and who she can treat within her scope of practice. Based on risk assessment, ability, training, and law. They may or may not take on clients with higher risks like twin births, vbac, breech, etc. Typically, a CPM has more flexibility in these areas. Where a CNM usually must practice under an OBGYN or under regulations, and so is more limited in what they can offer under their practice.
It is important to protect our midwives in our communities. Their names, their practice, and our ability to choose where, and how, and with whom we birth- rests in this protection and responsibility.
Back to the birthing family, and original question.
Is home birth legal?
Yes. Any legal risk is taken on by the midwife of choice. Not the family.
That being said, there is still risk for home birth families. On paper, laws are laws. But in reality, our birthing options are affected by things far less solid than paper.
Birth outcomes in hospital, and birthing choices at home, are affected greatly by bias, racism, fear, and inequality. When planning a home birth, it is important to surround yourself with a team and a support system of people who respect home birth. Many people are afraid of it because of the way birth is portrayed in our culture, and because of the unnecessary hostility that western medicine practitioners often place on anyone who practices or looks differently then them. Because of this fear, there is risk. That is not to say it is not worth the risk.
Choosing home birth, is an amazing beautiful choice. Often times, a safer choice for those who are at a higher risk of trauma in hospital. But it is more than choosing where to birth. It is a lifestyle choice that can follow you into your postpartum and your babies future. You have to be willing to walk alternative paths, willing to accept the risk that comes from others not understanding your choices.
Home birth is legal. But it comes with risk just like hospital birth comes with its own set of risks. The choice, is not how to be brave enough. It takes great bravery to birth in hospital too.
The question, is not whether you can do it or not. You will birth your baby, one way or another, wherever you are when the time comes.
The question when choosing where to birth, should always be about where you feel the safest. The most supported. For many many people that is at home. Home birth is a safe, valid, and legal choice. <3
This is such a big topic. If you have follow up questions, or want to talk in depth about the risks you might face personally in any birthing situation, message me to book a consult or zoom call, or submit further questions in the "Ask Oriana" box below.
I support births of every type, in every location. I believe in the freedom of birth, and the freedom of choice and informed consent.
Thank you so much for submitting this important question.
-Your Wildwood Birthkeeper, CordeliaGrey Oriana Allen