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July 12, 2011

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US moms opting for home birth

MORE and more well-educated and well-informed American women are deciding to give birth at home. Leanne Italile looks at the reasons and talks to mothers, midwives and doctors.

One mother chose home birth because it was cheaper than going to a hospital. Another gave birth at home because she has multiple sclerosis and feared unnecessary medical intervention. And some choose home births after cesarean sections with their first babies.

Whatever their motivation, all are among a striking trend: Home births increased 20 percent from 2004 to 2008, accounting for 28,357 of 4.2 million US births, according to a latest study from the Centers for Disease Control and Prevention.

White women led the drive, with 1 in 98 having babies at home in 2008, compared to 1 in 357 black women and 1 in 500 Hispanic women.

Sherry Hopkins, a Las Vegas midwife, said the women whose home births she's attended include a pediatrician, an emergency room doctor and nurses. "We're definitely seeing well-educated and well-informed people who want to give birth at home," she said.

Robbie Davis-Floyd, a medical anthropologist at the University of Texas at Austin and researcher on global trends in childbirth, obstetrics and midwifery, said "at first, in the 1970s, it was largely a hippie, countercultural thing to give birth outside of the hospital. Over the years, as the formerly 'lay' midwives have become far more sophisticated, so has their clientele."

The American College of Obstetricians and Gynecologists, which certifies OB-GYNs, warns that home births can be unsafe, especially if the mother has high-risk conditions, if a birth attendant is inadequately trained and if there's no nearby hospital in case of emergency. Some doctors also question whether a "feminist machoism" is at play in wanting to give birth at home.

But home birthers say they want to be free of drugs, fetal monitors, IVs and pressure to hurry their labor at the behest of doctors and hospitals. They prefer to labor in tubs of water or on hands and knees, walk around their living rooms or take comfort in their own beds, surrounded by loved ones as they listen to music or hypnosis recordings with the support of midwives and doulas. Some even go without midwives and rely on husbands or other non-professionals for support.

Julie Jacobs, 38, of Baltimore, who has multiple sclerosis, said she "chose midwives and hypnosis because I wanted to surround myself with people who would support me as a birthing mother, rather than view me as an MS patient who would be a liability in need of interventions at every turn."

Her first two children were born in a freestanding birth center operated by midwives. After the center closed, her third child was born at home in 2007. "If I had been in a hospital I probably would have had C-sections for all three," she said. "With the first, I would have been terrified to try a home birth. After the second one I was like, hey, I can't necessarily walk in a straight line, but I can do this."

Some home birthers cite concerns over cesarean sections. The US rate of C-sections in hospitals hovers around 32 percent, soaring up to 60 percent in some areas. In some cases, there's a "too posh to push" mentality of scheduled inductions for convenience sake (Victoria Beckham had three).

Gina Crosley-Corcoran, a Chicago blogger and pre-law student, had a C-section with her first baby and chronicled nightmarish pressure from nurses and doctors to abandon a vaginal birth with her second. She followed up with a third child born at home in April.

"I do think there's a backlash against what's happening in hospitals," she said. "Women are finding that the hospital experience wasn't a good one."

In Portland, Oregon, acupuncturist Becca Seitz gave birth to both her children at home, the first time in 2007 because she and her husband were without insurance.

"It was never on my radar, until we couldn't afford otherwise," she said. "I'm granola, but not that granola. It cost us US$3,300, as opposed to over US$10,000 in a hospital."

Her midwife was prepared with the drug Pitocin, oxygen and other medical equipment.

"They were both born over the toilet," she said. "It was a nice position. It's a way that we're used to pushing."

Dr Joel Evans, the rare board-certified OB-GYN who supports home birth, said the medical establishment has become "resistant to change, resistant to dialogue, resistant to flexibility."

"Women are now looking for alternatives where they can be treated as individuals, as opposed to being forced to comply with protocols, which however well meaning, have the impact of both medicalizing childbirth and increasing stress and anxiety around delivery," said Evans, founder and director of the Center for Women's Health in Stamford, Connecticut, and an assistant clinical professor at the Albert Einstein College of Medicine in New York.

By some accounts, in 1900, 95 percent of US births took place at home. That slipped to half by 1938 and less than 1 percent by 1955.

Today, most midwife-attended births take place in hospitals in the US, and many midwives are licensed nurses. But there are also close to 1,700 midwives who practice outside of hospitals, said Davis-Floyd. In 27 states, so-called "lay" midwives who lack nurses' training but are licensed and certified as professional midwives can attend births legally.

Some women chose home births after learning about it from TV shows or documentaries.

The show-all "House of Babies" on Discovery Health Channel from 2005 to 2009 was filmed at a Miami birth center run by a midwife.

Actress Ricki Lake screened her movie, "The Business of Being Born," around the US in 2007 after giving birth at home to her second child.

The film also showed Lake's filmmaking partner, Abby Epstein, documenting her own frantic taxi ride to a New York hospital after abandoning her home birth because the baby presented feet first, with the umbilical cord wrapped around his neck.

Michael Robertson, 27, of Poulsbo, Washington, knew nothing about home birth before watching the TLC series.

"I just really had my mind set on a water birth, like on the show," she said. "It looked so cool, so relaxing."

She had two babies at home, but opted for a planned hospital delivery for her third child due to complications. She's glad she had the choice.

"If you don't know your options, you don't know what's out there to begin with," she said. "I don't think an OB will say to you, 'Hey, did you know there was this thing called home birth'."

Most studies of home birth have been criticized as too small to accurately assess safety or distinguish between planned and unplanned deliveries, according to researchers Kenneth C. Johnson and Betty-Anne Daviss.

In 2005, they published a study in the British Medical Journal based on nearly 5,500 home births involving certified professional midwives in the US and Canada.

The study, considered one of the largest for home births, showed 88 percent had positive outcomes, while 12 percent of the women were transferred to hospitals, including 9 percent for preventive reasons and 3 percent for emergencies.


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