Informed Choice Agreement

Homebirth is presently an unconventional choice in childbirth and includes a
different set of responsibilities, benefits and risks than hospital birth. We provide care
for normal pregnancy, labor, homebirth and the period postpartum. We give care as a
team – you will see us both prenatally, two midwives will attend your birth and we are
on call at all times.
As a pregnant woman/couple, you have the right and the responsibility to
participate in all aspects of your care, including asking questions, seeking other
opinions, and making choices. The relationship between midwife and client is
collaborative. We believe that pregnancy and birth are fundamentally healthy processes
and as each woman is unique; her care should be tailored to meet her individual needs.
Attending to the emotional and spiritual components of childbearing is as important as
adequate health care.
There are both advantages and disadvantages to homebirth, and you must
decide which birth setting feels best for you. Homebirth allows more control over how
you will birth and who will be with you. Unlike in some hospitals, you will not be
pressured to have routine IV’s, electronic fetal monitoring, on-your-back delivery
(unless you choose this position), or episiotomy, but instead will be supported in your
own ways of moving through the laboring process.
The main disadvantage of homebirth is the limited availability of emergency
equipment and personnel. Midwives do bring oxygen, anti-hemorrhagics, infant
resuscitator and suctioning devices to homebirths, and are certified in CPR as well as
neo-natal resuscitation. However, most obstetrical complications are not emergencies,
and many are predictable before hand. Complications are best minimized with a healthy
mother who maintains good nutrition and receives skilled screening and consistent
prenatal care. True emergencies are rare, and usually allow sufficient time to get to the
hospital, but three are no guarantees. You must weigh for yourself the risks of birthing
outside an emergency facility against the risks of in-hospital birthing, where
unnecessary interventions, emergency-mentality, and hospital-borne infections present
their own dangers. Babies (and very rarely, mothers) do sometimes die in spite of the
best care and great love. It happens at home and in the hospital.
The statistics on safety are not conclusive; some studies contend that hospital
birth is safer, while others say homebirth is safer. Still others suggest that birth setting
matters less than birth attendants. Midwives are, in general, less interventive than
physicians. Midwives believe that homebirth is safe, but that there is a place for hospital
also. Hospitals are vital for women and babies with complications, and for those who
feel uncomfortable giving birth at home. Ultimately, the choice is yours.
It is legal to have a homebirth in this and every state. However, independent
midwives are not currently licensed or regulated in the Commonwealth of
Massachusetts. Through the efforts of the Massachusetts Midwives Alliance (MMA)
legislation to establish a Board of Registration of Midwifery has been proposed for seven
years. Each time it was favorable voted on in the Joint Health Care Committee, but never
progressed further in the legislative process.
Independently trained midwives often receive their experience through handson
apprenticeship training as well as education through schools, workshops and
courses. We are trained midwives, members of MMA. Though some independent
midwives are also trained as nurses and nurse-midwives, we are not working under
these trained titles. Independent midwives are not doctors or any other medical
practitioner regulated and licensed under Massachusetts law. The MMA is a
professional organization which, to ensure the highest quality of care, has its own
certification process, peer review and protocols for practice.
We do not carry malpractice insurance.

In order to fully represent traditional midwifery, it seems important to bring up
the political realities of making this choice for homebirth. We cannot separate individual
circumstances from the social and political contexts in which they occur. As independent
midwives we place ourselves outside the mainstream medical framework. We recognize
our work as revolutionary: part of a worldwide movement of women and families to
reclaim their health care and the right to take personal responsibility and make choices.
In choosing the care of independent midwives and homebirth. It is important to realize
that you, too, enter this political arena.
In choosing homebirth and independent midwifery care, you are going against
what our culture expects of “responsible” adults. Your role as responsible parents may
be questioned because many authorities consider homebirth to be child abuse or neglect.
It is ironic that the more personal responsibility you assume, the less responsible you are
perceived to be. For example, if birth results in death or damage in the hospital, no one
will come to you and say, “See what happens when you have a baby in the hospital?”
However, if a problem arises at home, you will invariably be asked this question
regarding homebirth again and again. In the midst of the personal crisis surrounding the
complication there may be relatives, friends, doctors, lawyers, ambulance attendants
and the police demanding information, explanations, and perhaps pressing charges
against your midwives. In such a situation, would you still clearly feel that homebirth
was the right choice for you? If not, please discuss it with you midwives further so that
help can be given to clarify your decision about the most appropriate situation for you.
Midwives strive to create an open and trusting relationship with you that
recognizes the inherent lack of guarantees in life and birth. We depend upon you, our
clients, to stand behind us incases of problems in the same way that we place ourselves
at political risk so that you can have your choice of care and birthplace.

I/We have read and agree to this Informed Choice statement. All of our questions
regarding our midwives and homebirth have been answered to our satisfaction.

 

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Pregnant Client’s Signature ...............................................................Date

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Partner of Client’s Signature .............................................................Date