I am a woman who has experienced five births.  The first was with an OB/GYN, the second two were with CNMs in a hospital-based birth center, and the last 2 were at home with a CPM.  I have a lot of interest in the field of childbirth, as well as a background in an unrelated medical field.

I can honestly say that of the health care providers I had, I received the fullest disclosure from the CPMs who attended my last two births. After them, the CNM's who attended the second and third births, and finally, I do not believe that I had full disclosure from the OB/GYN who was present when I birthed my first child. Some things just never appeared to come up in discussion, such as losing the opportunity to eat while in labor, or what the definition of high blood pressure actually is.

The wording of the NOIRA tacitly assumes that giving birth outside the hospital is the only thing that needs risk disclosure. There are no guidelines for equivalent evidence-based risk guidelines for giving birth in a hospital setting, although there are documented risks for doing so, such as infection.. This is an obvious disparity that should be taken into consideration and addressed.

I am also concerned about the whole idea of more regulation. There are so many examples in which the guidelines that label a woman as “high-risk” are relative at best and completely arbitrary at worst. Evidence-based guidelines for risk for birth in all settings will put birthing women on an even footing and empowered as they make their own choices, but it does seem that more regulations will put more limitation and less choice for women. Certified professional midwives assess continually throughout the pregnancy and birth for risk. Each birth is considered in and of itself. Excessive external guidelines will remove their ability to assess each woman for safety as a “full picture.”

I felt the greatest amount of control in the births with CPMs. I felt that I had full disclosure about every health issue, and I was in control of each birth. Childbirth is a natural process of women's bodies, and nothing so much as autonomy in birth can enable their choices in their lives and regarding their children and families.