My response to the denial of my home birth referral.

26 July 2010

Sir,

This letter represents my formal request for reconsideration of my referral for home-based obstetrical care, specifically childbirth at home under the supervision of a licensed Certified Nurse-Midwife (CNM). My referral was denied on the basis of, “OB care available at Eglin.” However, the type of obstetrical care I am requesting is not available at Eglin, as none of the Ob-Gyns or CNMs on staff attend home births.

It is my desire to deliver my baby as safely and naturally as possible, utilizing medical intervention only in true necessity. When I gave birth to my daughter last year at Houston County Medical Center in Warner Robins, GA, I was fortunate to have an extremely supportive medical staff that respected my birth plan and allowed me to both labor and deliver according to my personal needs, free from the direction of a standard operating protocol. I was not required to submit to electronic fetal monitoring, iv/heplock, etc. However, having already discussed my birth plan (please see attachment) with care providers at Eglin, I have been made aware that interventions such as these are standard, and that I will not be permitted to refuse several of them.

Therefore, in order to receive the type of obstetrical care I require to deliver intervention-free, a home birth is the most prudent choice. Numerous studies attest that for women with low-risk pregnancies and no complications, homebirths result in equally good or better outcomes for both mother and baby than hospital births. In one example, Janssen et. al. (2009, p. 377; attached) found that “Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.” Specifically, women who experienced home births as opposed to hospital births were significantly less likely than those who had hospital births to undergo electronic fetal monitoring, assisted vaginal delivery, third- or fourth- perineal tear, and postpartum hemorrhage. Further, newborns in the home-birth group were less likely to require resuscitation at birth or oxygen therapy past 24 hours, and had lower incidence of meconium aspiration.

Regardless of the documented safety of home birth, midwives are required to equip themselves to handle common events surrounding childbirth; by Florida statute (Chapter 64B24-7 Midwifery Practice, 7.006 Preparation for Home Delivery; attached), they must possess, amongst other items, sterile obstetrical packs and oxygen. Additionally, risk assessments must be routinely and consistently conducted; if any of the complications indicated in Chapter 64B24-7 Midwifery Practice, 7.004 Risk Assessment (attached) are identified, immediate hospital transfer must occur. For these reasons, arrangements for hospital transfer would be in place prior to the birth of my child. Further, if at any point my candidacy for a safe home birth was threatened by any of the pregnancy complications outlined in 7.004, I acknowledge that I would immediately request referral back to the MTF for prenatal care.

Finally, Tricare routinely reimburses home birth-related costs for its Basic beneficiaries, as well as for Prime members who are either not assigned to or are able to secure a referral from an MTF. To me, this signifies Tricare’s recognition of home birth as a safe choice, as well as a distinct type of obstetrical care not provided by an MTF.

For these reasons, I respectfully request that you reconsider my referral for home-based obstetrical care.

Respectfully,

Emily I. Nolan

Attachments:
1. Birth plan
2. “Outcomes of planned home birth with registered midwife,” Janssen et. al., 2009.
3. Florida Statute Chapter 64B24-7 Midwifery Practice