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ACNM Responds to Recent Media Coverage of Community Birth

December 18, 2018
Contact: Maura Christopher 
240-485-1822; [email protected]

Silver Spring, MD:
The American College of Nurse-Midwives (ACNM) has endorsed the Midwives Alliance of North America's (MANA) response to the recent Gatehouse media coverage of community birth, which focused on poor outcomes for some home birth and birth center families. ACNM offers our deepest and most heartfelt sympathies to the grieving families that were profiled in this series.

ACNM is the organization that represents certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States. While 94% of births attended by CNMs/CMs occur in the hospital setting, CNMs/CMs also provide care to families who give birth in the home and in birth centers (1,2). Studies show overall integration of midwives across birth settings is associated with significantly higher rates of spontaneous vaginal delivery, vaginal birth after cesarean, increased rates of breastfeeding, and significantly lower rates of cesarean births, preterm birth, low birth-weight infants, and neonatal death (3).

ACNM believes that every family has the right to experience childbirth in a safe environment where human dignity and self-determination are respected (4). We also believe in the autonomy of all women to make informed choices about the place of birth that best meets their needs through informed consent and shared decision-making. Shared decision-making is a process through which women and families collaborate with their health care provider to make health care decisions (5). The ethical principles of autonomy, beneficence, nonmaleficence, and justice inform midwives' relationships with the women and families they serve, and CNMs/CMs, according to our ethical standards, are responsible for providing all relevant information to women and families when they are making decisions about their choice of birth setting (4,6). Consistent with the ACNM Standards for the Practice of Midwifery, each midwifery practice, regardless of setting, develops comprehensive clinical guidelines that address access to consultation, collaboration, and referral, which include a process to facilitate transfer of care if necessary (7). ACNM has endorsed the Best Practice Guidelines: Transfer from Planned Home Birth to Hospital. These guidelines were developed in 2014 by the Collaboration Task Force of the Home Birth Summit, comprised of physicians, midwives, nurses, hospital administrators, and consumers (8). This work was undertaken to ensure improved experiences and outcomes for women and families who choose home birth and birth center birth in support of having an integrated system of transfer and referral when necessary.

It is of the utmost importance that families choosing to birth at home or in a birth center be supported by an integrated, supportive system of safe and seamless care. This care should consist of respectful care and collaboration among all health care providers should a transfer to the hospital become necessary. ACNM strongly believes all maternity care providers should be working together to create integrated systems of maternal health care throughout the United States.

Moving forward, there is need for further dialogue and additional research. Health care organizations, perinatal care providers, policy-makers, regulators, and other stakeholders must collaborate on developing systems that reinforce safety and that comprehensively meet the maternal health care needs of women and families. The voices and stories within all communities must be the foundation on which these systems are constructed. We have a professional and ethical responsibility to make the options available for birthing families as safe as possible through sustained efforts to build an integrated system of respectful, comprehensive maternity care throughout the United States. ACNM remains firm in its commitment to advance clinical excellence and optimal outcomes in all birth settings.


1. American College of Nurse-Midwives.Definition of Midwifery and Scope of Practice of Certified Nurse-Midwives and Certified Midwives. Bit.ly/2CpwHS9. Updated December 2011. Accessed December 5, 2018.

2. Hamilton BE, Martin JA, Osterman MJK, Curtin, SC, Mathews TJ. Births: Final Data for 2014. National Vital Statistics Reports; Vol 64, No 12. Hyattsville, MD: National Center for Health Statistics. 2015.

3. Vedam S, Stoll K, MacDorman M, Declercq E, Cramer R, Cheyney M, et al. (2018) Mapping integration of midwives across the United States: Impact on access, equity, and outcomes. PLoS ONE 13(2):e0192523. doi:10.1371/journal.pone.0192523.

4. American College of Nurse-Midwives. Clinical Bulletin no. 14. Midwifery Provision of Homebirth Services. Journal of MidwiferyWomen's Health. 2015;61(1):127–133. doi:10.1111/jmwh.12431.

5. American College of Nurse-Midwives. Position Statement. Shared Decision Making in Midwifery Care. Bit.ly/2SUaAs4. Approved December 2016. Accessed November 30, 2018.

6. American College of Nurse-Midwives. Code of Ethics. Bit.ly/2ddO5v8. Reviewed December 2013. Accessed December 6, 2018.

7. American College of Nurse-Midwives. Standards for the practice of midwifery. Bit.ly/2A8DbDg. Update September 2011. Accessed December 5, 2018.

8. Home Birth Summit. Best Practice Guidelines: Transfer from Planned Home Birth to Hospital. Bit.ly/2BtbiWb. Published May 2014. Accessed December 6, 2018.

About ACNM

With 6500 members, ACNM is the professional association that represents certified nurse-midwives (CNMs) and certified midwives (CMs) in the United States. ACNM promotes excellence in midwifery education, clinical practice, and research. With roots dating to 1929, our members are primary care providers for women throughout the lifespan, with a special emphasis on pregnancy, childbirth, and gynecologic and reproductive health. ACNM provides research, administers and promotes continuing education programs, establishes clinical practice standards, and creates liaisons with state and federal agencies and members of Congress to increase the visibility and recognition of midwifery care.

American College of Nurse-Midwives
8403 Colesville Rd. Ste. 1230 Silver Spring, MD 20910
Phone: 240.485.1800 Fax: 240.485.1818
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