Story by Kelly Kenoyer
Photo by Mary-Jane Schulte
Instead of a desk and papers, Amanda Moore’s home office is furnished with a bed and a closet of medical supplies. The room is decorated with soothing shades of green and unusual birth-themed decor. The bed is sometimes replaced by a tub for mothers who prefer the soothing presence of water during one of the most painful and miraculous moments of their lives. Moore is a certified midwife.
“My job is to honor the family and to make sure everything is safe,” she says.  “Most of the time, what’s really needed is a lot of love and encouragement, and I think that is the midwife’s space. They’re trained in the tradition of midwifery, of honoring the mother, the family, and the child.” Moore has a warm, calm demeanor and a soft voice. Her graceful movements are often interrupted by her sweeping her hair behind an ear. She serves 12 to 24 expecting mothers each year. “I’m friends with a lot of my patients, I feel like they’re family to me,” she says. Moore describes the wonder and the empowerment that comes with home births. She explains how hormones like oxytocin can make birth as pleasurable as it is painful, so long as the woman isn’t fearful and full of adrenaline. “When a woman is delivering in a hospital, her privacy is violated. There are a lot of interventions in the hospital and a lot of fear, which creates that adrenaline and negates oxytocin levels in the body,” explains Moore.
Midwifery is considered by many to be a natural alternative for mothers who perceive hospital births as antiseptic and impersonal. A home birth holds appealing familiarity and sense of comfort. Since a midwife maintains a relationship with the mother for their entire pregnancy, the midwife has plenty of time to adapt to the birthing situation and help the mother have a natural birth. However, recent deaths like that of Bethany Reed’s daughter in 2011 have placed blame on unregistered midwives doing home births. This incident, and several other similar cases, has called many safety standards into question and brought about talks of licensure for midwives.
On July 6, 2013, legislation was passed requiring all midwives to be registered by the state, so Certified Professional Midwives (CPMs) like Moore must pass two exams and participate in more than 50 deliveries, 100 prenatal care visits, and 60 examinations before they are legally licensed to provide midwife care. According to Moore, these standards of midwifery education have been a barrier in CPMs starting their own home practices. “Midwifery is so much deeper than getting a certificate at some school. A traditional midwife serves her community and was trained by her preceptor, another midwife, through an apprenticeship model. That model is being killed off,” says Moore. Despite the appeals of midwifery, approximately 99 percent of births in the US still occur in hospitals, and more than 30 percent of which are commonly practiced cesarean sections, a serious abdominal surgery that was once used solely in emergency situations.
Michael Hare, a retired doctor from Salem Hospital, feels that birthing options should be an informed choice. “Wherever someone feels most comfortable is best, so long as they have somebody attending them who knows what they’re doing and also knows how to call someone in a hurry. You need someone knowledgeable with you and somebody comfortable with you,” says Hare. While home births and women’s clinics seem to have an edge on providing comfort to expecting mothers, many hospitals are trying to get in on the trend by creating homey birthing rooms. Some hospitals even have baths for mothers who might prefer a water birth. “Everyone has realized that [it’s best] if the mom is relaxed. No matter how many technicians are hiding in the background close by, at least they can have the feeling that they’re at home,” says Hare.
Brooke Kyle, a physician at Women’s Care, an obstetrics and gynecology practice in Eugene, Oregon, thinks she can provide both the comfort of a home birth and the safety of a hospital birth. “There can be events during labor and birth where delivery should occur within 30 minutes or less to ensure a healthy baby. With a home birth, it is impossible to expedite birth within those time guidelines. My goal is a healthy baby and mother, so I combine the positive thoughts and hopes of a midwife’s care with the expertise of a doctor’s care,” says Dr. Kyle. Her practice, however, does not perform births in the mother’s actual home. Midwives like Moore perform many of their prenatal checkups in the home as well as the actual birth.

Moore feels that a true home birth is far better than one in a hospital, when it comes to feeling at ease. “Women who choose home birth seem to share their stories with their friends, and those stories are really powerful amongst women talking about their birth experience,” explains Moore. In a home birth, the woman is completely supported throughout her pregnancy.” According to Moore, this start to finish model of care is much more common
with a midwife. “We’re with a mother for nearly a year of her life, till the baby is 6 weeks old, but women in the hospital are subjected to rotating staff, bright lights, machines, beepers, and doctors they might not even know,” she says. Moore claims to provide an optimal amount of care, both before and after the child is born. “I check in with the mother’s health and ask her if she’s getting enough sleep, and usually I offer to help with the d
ishes or put her older kids in the bath. It’s my role to help [the mother] with the transition of adding another child to her family.”
Dr. Kyle feels that she provides similar care to a home birth in her women’s clinic, but with increased safety. “For pregnancy care, we see patients after the pregnancy test is positive. We see women every four weeks until the third trimester, every two weeks until a month before their due date, every week afterwards and whenever they have an urgent concern.”
Dr. Kyle feels that licensure for midwives is necessary, and is pleased with the recent legislation. “I do believe lay midwives (those without medical training, such as Direct Entry Midwives or Certified Practical Midwives) should be licensed. Licensure is required for the person who provides a pedicure. Should it not be the same for a person who delivers your baby?” From a medical standpoint, the safety of the mother and the child comes before anything else. Moore agrees with the importance of safety, but doesn’t think licensure is the way. “Uncertified midwives in the state of Oregon have better outcomes than the licensed midwives. Statistically, it is black-and-white: Licensing does not ensure a competent practitioner.” Although Moore herself is licensed, she feels that providing a range of options to the mother is a high priority, and that the mother’s choice of care should be respected as long as she is aware of the risks involved.
Beyond a home birth or a hospital birth, expectant mothers have a wide range of care options. Throughout Oregon there are plenty of birthing centers that employ certified nurse midwives who can prescribe antibiotics and pain relievers after extensive education and nursing school. Such centers often employ OB/GYNs like Dr. Kyle in case a medical doctor is needed to perform an emergency surgical birth or another advanced procedure. Licensed midwives have completed an additional ten births and specialized training that allows them to prescribe additional medications. All the experience required of CPMs has taught Moore a great deal about the needs and comforts required for a healthy and natural birth.
The earth-toned, pine-scented living room of Moore’s home is lined with musical instruments, often used to soothe a mother in labor. Many mothers find comfort in the music, and the soft smells make the entire atmosphere warm and relaxed. Although her home can be a haven for mothers in labor, the question of safety still permeates through midwifery. While hospitals have all the advantages of new technology, midwives have thousands of years of expertise and knowledge passed down to them. Ultimately, the decision lies with the mother. Her ability to choose is perhaps the most important part of the debate. “I believe in midwifery,” Moore says enthusiastically. “I know that birth is ancient, and it’s way more powerful than our society honors or empowers women in the family dynamic. I believe that a healthy planet and a healthy family begins when you make healthy choices.”

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Jane Rittenhouse, a mother of five, is an advocate from personal experience for the practice of midwifery and natural births.