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Published November 18, 2013, 03:34 PM

Having baby at home: Film gives behind-the-scenes look at midwife-assisted home birth

ST. PAUL – Thirty-six-year-old Sarah Biermeier doesn’t fit the midwife stereotype. “I’m not a hippie with a long, flowing dress and Birkenstocks waving my smudge stick around,” she says with a laugh.

By: Meredith Holt, INFORUM

ST. PAUL – Thirty-six-year-old Sarah Biermeier doesn’t fit the midwife stereotype.

“I’m not a hippie with a long, flowing dress and Birkenstocks waving my smudge stick around,” she says with a laugh.

In an effort to show what home-birth midwifery is really like, Biermeier agreed to let friend Allison Kuznia, a 36-year-old St. Paul filmmaker, document her first year as a certified professional midwife.

“I feel like there are so many different documentaries on birth, but there’s nothing on the behind-the-scenes,” Biermeier says.

Kuznia, whose mom lives in Moorhead, will attend a screening of “Midwife” on Saturday at the Fargo Theatre, but Biermeier has to stay close to home for three of her expectant mothers who are near their due dates.

The 104-minute film shows four home births assisted by Biermeier, who started her Twin Cities-based company, Geneabirth, seven years ago as a doula, someone who provides non-medical assistance to women during labor.

None of the women were first-time mothers, though one wanted to have a natural birth after having two previous C-sections, referred to as a VBAC (vaginal birth after cesarean).

Biermeier, who’s helped deliver about 350 babies, says home birth is a safe option for many women, including those who’ve had cesareans.

However, some members of the medical community question the safety of home births.

CPMs like Biermeier are certified by the North American Registry of Midwives but aren’t legally authorized to practice in 22 states, including North Dakota and South Dakota.

In a paper published in January 2012’s American Journal of Obstetrics & Gynecology, a group led by author Dr. Frank Chervenak said home-birth-like experiences in hospitals are safer, more satisfying and more cost-effective for patients than planned home births.The authors of the paper went on to discourage

obstetricians, physicians andmidwives of all types from supporting planned home birth “when there are safe and compassionate hospital-based alternatives and to advocate for a safe home-birth-like experience in the hospital.”

Biermeier, a mother of five, admits she was a little nervous about how the birth complications that occurred during filming would be received by audiences. Three of the babies needed help getting out, and one needed mouth-to-mouth.

But Kuznia reassured her, saying, “So many women are afraid because of the what-ifs, and we’re showing the what-ifs and that they can still safely be handled at home.”

Kuznia and Biermeier believe women in every state should be able to choose where they give birth and who’s present.

“We have the right, as women, to choose whether or not we want to continue to stay pregnant, but moving forward with the pregnancy, we don’t have the right to have a qualified birth attendant,” Biermeier says.

“Midwife” explores the movement to change that.

HOME VS. HOSPITAL

To some, at the root of the hospital-vs.-home-birth debate is how labor and birth are viewed.

Biermeier says birth is no longer seen as its own event – it’s seen as “the way to get the baby.”

“The doctors seem to think that it’s their birth, their baby and their placenta,” she says.

“I’m there to make sure everything goes smoothly, but it’s not about me, and it’s never been about me.”

Biermeier says “Midwife” wasn’t intended to get more women to switch to home births, but rather to get them to consider all of their birthing options.

“More and more people are beginning to question common birth practices in hospitals,” she says.

Anne Gilbertson, a certified nurse midwife with Sanford Health in Alexandria, Minn., doesn’t feel comfortable doing home births but does think women should have the option.

“Women need to decide what’s important to them and then pick a provider who will support their choices,” whether it’s an OB, a family-practice doctor or a midwife, she says.

Gilbertson says if they want a home birth, they should first devise a backup plan and be screened to make sure they’re low risk.

The main difference between a CPM like Biermeier and a CNM like Gilbertson is in their training.

CNMs are dually trained in nursing and midwifery, with bachelor’s and usually master’s degrees. They receive their training in a hospital setting and typically prefer to work in a hospital, clinic or birthing center.

Only 2 percent attend home births, according to the American College of Nurse-Midwives.

Depending on the state, CNMs may be required to have a collaborative agreement with a physician approved by the Boards of Medicine and Nursing in order to attend a home birth.

Kuznia says CPMs, on the other hand, don’t want to be nurses or train within a medical system. They get their training through the apprenticeship model or a midwifery school.

Another difference is CNMs can provide care from the onset of menstruation through menopause like a gynecologist, but CPMs generally stick to the first prenatal visit to the six-week postpartum exam.

“CPMs are the only U.S. birth attendant whose education and clinical training focuses specifically and exclusively on out-of-hospital birth settings,” she says.

STILL LEARNING

Before “Midwife,” Kuznia had three home births of her own and worked as a birth photographer for six years.

“That’s when I started noticing the value and the worth of a home-birth midwife,” she says.

She wants her film to show audiences what the presence of a midwife adds to a birth. She talks about how Biermeier “holds the space.”

“Their role is to help the mother ‘trust’ in birth and give her a safe and healthy birth with respect and honor,” she says.

Biermeier and Gilbertson took different paths to midwifery, but both women were inspired by their own birth experiences.

Gilbertson decided to become a CNM after the birth of her first child.

“I was fortunate to have a really great midwife with my first birth. That experience really was empowering to me, and I wanted to be able to provide that for other women,” she says.

It was between her second and third children that Biermeier felt the calling.

With a long apprenticeship, she went from doula to certified professional midwife.

Unlike a CNM or a CPM, a doula has no responsibility for the health and well-being of the mother and child, Beirmeier says. She’s there to provide information and physical and emotional support, like a birthing coach.

So is a midwife, but with the certification comes added responsibility.

“It was a very smooth transition in a time when getting an apprenticeship was really difficult,” she says.

Hundreds of babies later, Biermeier’s still learning, and she says any type of midwife would agree.

“You’re constantly re-examining and changing your ideas and letting go of preconceived notions,” she says.

Readers can reach Forum reporter Meredith Holt at (701) 241-5590

Midwife Documentary - Trailer from Allison Kuznia on Vimeo.

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