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A Feminist Perspective on the Study of Home Birth Application of a Midwifery Care Framework


  • Sylvia Bortin FNP, CNM,

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    • Sylvia Bortin is a family nurse practitioner and certified nurse-midwife. She has worked in home, hospital, and out-of-hospital birth center practices. She received her nursing education from Cabrillo College, Aptos, California, in 1973. She received a BSN and FNP from Boise State University, Idaho, in 1977, and a CNM certificate from the Stanford Women's Health Care Training Project in 1984. She received a master of science degree at University of California, San Francisco (UCSF) in 1994. She currently works at the Santa Cruz Women's Health Center in California.

  • Marina Alzugaray RNP, CNM,

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    • Marina Alzugaray received her nurse-midwifery certificate from UCSF in 1981 and a BA in Health Science from Antioch University, Santa Barbara, California, in 1984. She directed Santa Barbara Midwifery, a private home birth practice, for eight years. She is a member of the ACNM home birth ad hoc committee, works as a locum tenens for several midwifery services. She received a master of science degree from UCSF in 1994.

  • Judy Dowd NP, CNM,

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    • Judy Dowd is a certified nurse-midwife and Ob/Gyn nurse practitioner, and is a graduate of the UCSF/San Francisco Nurse Midwifery Education Program. She received her BS in Nursing at UCSF in 1991 and Master of Science degree in Nursing from UCSF in 1993. She has been a direct entry midwife and had a home birth practice in the Boston, Massachusetts, area for five years. She is currently working at the Westside Community Health Center in Santa Cruz and the Hershey Clinic Medical Group in Salin as, California.

  • Janice Kalman RN

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    • Janice Kalman received her BA in Anthropology from Pitzer College in 1983. She became a direct entry midwife, completing an apprenticeship as well as formal education at the Maternity Center in El Paso, Texas, in 1986. She practiced as a home birth attendant in a rural area for several years before entering the Master's Entry Program in Nursing at UCSF in 1991. She received her RN in 1992 and completed a master of science degree in 1994.

  • The authors' decision to use the first person in this article reflects our adherence to a feminist perspective and our belief that scientific writing and research occurs within a context, and is never completely objective.

Sylvia Bortin, CNM, FNP, 381 26th Avenue, Santa Cruz, CA 95062.


Studies of home birth have compared it with hospital birth, with a focus on perinatal outcomes. Although such studies have established the safety of midwife-attended home births, this narrow view does not include all of the concepts represented in a proposed midwifery care framework derived from the philosophy of the American College of Nurse-Midwives. In this essay, the authors recommend the employment of qualitative research with a feminist perspective as a method to elucidate other concepts in the midwifery care framework, and suggest that future home birth research should explore the recognition and validation of the woman and her experiences, appropriate use of technology, and the influences of the birth environment.