May 18, 2014

Dear Sir,

As a local Midwife who fought to be admitted to the Registrar for Midwives after several decades in the late 1990s, it was with a great concern that I read the letter to the Editor published by the Health Ministry regarding midwifery and home birth in Bermuda on May 13, 2104. It seems that in spite of large bodies of evidence and information regarding planned assisted homebirth, this debate has been reduced to a set of half-truths and misinformation.

It is also interesting to note that only US documents are referenced despite the US’s notable reputation as one of the worst countries in the industrialised world in which one can have a baby as reinforced by the State of the World’s Mothers published May 2014.

According to both the International Confederation of Midwives (ICM) and the American College of Midwives (ACNM) planned home birth by regulated midwives is a safe choice for families. In fact, Dr Tony Falconer, President of the Royal College of Obstetricians and Gynecologist RCOG, said: “The RCOG supports the choice of a home birth for low-risk women expecting a second or third baby. This large study reiterates the findings from the Birthplace study (https://www.npeu.ox.ac.uk/birthplace) which showed good outcomes for low-risk women and their babies who delivered in either midwife-led units or at home.

The Cochrane database which serves as the highest standard for medical research in the worlds has also published reviews that cite midwifery care as best for mothers. The United Nations itself states that “the world needs midwives more than ever”. I will never forget my conducting my first home birth in Bermuda in 1999 which resulted in a physical assault from a notable obstetrician.

The threat from full scope midwifery practice was perceived to be sufficient then and has only escalated in the intervening years. It was because of this that Lisa Blyden RN, RM and I formed ‘With Women’, which was vehicle to educate families on birthing choice bringing the Bradley method to Bermuda. It was through With Women that Bermuda’s most vocal birth activists were educated, born and continue to this day.

It is my hope that the conversation be ongoing with all of the relevant stakeholders and informed by true unbiased research and evidence which Committee opinions are not. I am in full support of a review of the outdated Midwifery Practice Act — however, even as is, this document allows for full scope midwifery practice. As a Doctorally prepared experienced midwife and former Department of Health staff member, I have offered my services to the Department of Health on several occasions over the years to assist with the development of protocols and standards for midwifery and homebirth, however they have not availed themselves of this opportunity.

In fact, it is with a view to quality and safety that Midwives on the Bermuda Register though separated by distance have used virtual meetings to discuss homebirth patient guidelines and protocols to govern practice in Bermuda.

With the ancient wisdom and modern intervention that is both Bermuda and professional midwifery today, it would be wonderful to envision a return to a time when the Maternal Newborn Health Department of the Department of Health once again turns back to facilitation of birth and family choice.

As I develop standards for midwifery for an entire developing African country, I am saddened that healthcare providers in my developed home continue to relate to free birth choice from a place of fear and ignorance.

DR PANDORA HARDTMAN RN, RM

Bermudian born and bred — International Midwifery Consultant