Home birth popular alternative for expectant mothers seeking hospital alternative

BY NOUR HABIB World Scene Writer
Sunday, January 13, 2013
1/14/13 at 10:22 AM

Correction
This story incorrectly attributed information about a home birth experience to Jennifer Schafer. The story has been corrected.

On Christmas Eve, Rachel Driver gave birth to a baby girl.

Jocelyn Lily Driver, at a healthy 6 pounds 14 ounces and 20 1/2 inches, was delivered into a tub in the living room of the Drivers' apartment.

Rachel and Jon Driver, whose own mothers had some home births, opted to have their first child at home.

"We wanted to have as natural a birth as possible, without unnecessary interventions," Rachel Driver said before the birth.

The decision meant that there would be no option of pain medications, which she acknowledged was hard. Although at one point during her contractions Driver fleetingly understood why women ask for an epidural, the birth went much better than she expected.

"I had psyched myself up for something horrible," she said. "But it was really great."

Although Jon Driver can't compare his daughter's birth to a hospital birth because he'd never experienced it, he liked having the baby at home because he felt like he was able to offer more help to his wife.

"I was able to rub her back, help her, get her water if she needed it, instead of being the middleman who had to ask permission for everything at a hospital," he said.

The couple agreed, given the choice, they'd do it at home again the next time.

Why a home birth?

Home births have been on the rise in the U.S. since 2004, according to 2012 data from the National Center for Health Statistics. Home births in the country rose by 29 percent from 2004 to 2009, according to the data. According to a 2010 Tulsa World story, in Oklahoma, births attended by midwives that occur outside of a hospital increased 54 percent from 2004 to 2007.

Faith Morie, who delivered the Drivers' baby, has been a midwife for a little more than five years.

Many of the women who opt for a home birth choose it for the same reasons as the Drivers - to have as natural a birth as possible, free of temptations of pain medications or other interventions they consider unnecessary, such as physicians' decisions to induce labor.

Some of those who give birth at home do it for religious reasons, or because they want only women involved in the labor process. For others, the decision is cultural or based on financial considerations, as home births can be less costly for those who have no medical insurance. Morie estimates that the services of a midwife range from $2,000 to $4,000. And for some, the relationship-based care and more one-on-one time that a midwife can offer is appealing.

Morie is a certified professional midwife, meaning she did not receive formal training at a hospital the way a certified nurse midwife does. She completed her training through the Association of Texas Midwives, through a combination of distance learning and apprenticing with certified midwives, then received her certification through the North American Registry of Midwives after passing exams.

Morie says not all women are candidates for home birth. She and most midwives usually only accept clients with low-risk pregnancies. Those who have gestational diabetes, high blood pressure, certain blood-borne diseases, genetic conditions or other risk factors are better off at a hospital, she said.

But for the rest, Morie believes home birth is a safe option.

And when complications arise, as they sometimes do, midwives transport their clients to a hospital, where they can receive the help they need.

Moms' experiences

Several Tulsa-area mothers say their home-birth experiences were wonderful.

Anna Transue, who gave birth to her first child in September, said she never wanted a home birth.

"I started out seeing a doctor," she said. "But as I was progressing through my pregnancy, it became clear that my philosophy was not lining up with the doctor's."

Transue said she had always aligned with the midwifery model of birth, and Ina May Gaskin's "Guide to Childbirth" book - published in 2003 - opened her eyes to the alternatives to hospital birth.

Transue argues that birth is a natural human function, not a disease or sickness that requires hospitalization.

"We are capable of birthing babies," she said.

So, seven months into her pregnancy, Transue switched to the care of Ruth Cobb, a certified nurse midwife. Transue originally intended to deliver at Cobb's birth center, a facility where women who work with a midwife can give birth, but she decided to avoid the additional fee and have Cobb deliver her baby at home.

"It was a really great experience," she said.

Transue had been anxious that a home birth would be messy and did not want people invading her space at home. But, she said, being in the comfort of her own home during the 10-hour labor turned out to be great.

Jennifer Schafer, a mother of three, agrees.

Although Schafer had her first two children at a hospital with no problems, she chose to deliver her third child at home.

She had heard that home births were powerful experiences, and hers was.

"It was more peaceful, in your own environment," said Schafer, who had her youngest child six months ago. She also liked being able to move around her home during her labor, rather than being restricted to a bed as she was in the hospital. And she didn't feel rushed through the whole process, she said.

Although the idea of having as natural a birth as possible had always been on her mind, Taylor Kilburn wasn't opposed to a hospital birth, if she could find what she was looking for. But she says an unhelpful conversation with her general practice doctor early in her pregnancy turned her away from looking for an option within the more traditional setting, such as working with a midwife at a hospital, and she reluctantly made the decision to have a home birth.

No one in her family or circle of friends had had a home birth before, but all were supportive, Kilburn said.

There were no complications during her delivery, and she was able to manage her pain by standing during the 28-hour labor, she said. If she had been required to stay in bed in a hospital setting, she says she is sure she would have requested an epidural after about eight hours.

The three women say they knew there were risks to a home birth, but they didn't think it was any riskier than a hospital birth.

"I really believe if a woman is low-risk, and you're working with a midwife or professional who know what they are doing, then having a home birth is completely safe," Transue said.

Differing statistics

Lynn Frame, an OB-GYN at St. John, is an opponent of home births.

Frame agrees that birth is a natural human function.

"Women have had babies for a million years before obstetricians," he says. "But for the last 200 years, medical science has improved the outcome."

Years ago, moms had a higher chance of dying during childbirth because of bleeding, infections or other complications. When more people began having hospital births, the deaths decreased, he said.

Frame said those who view home births as perfectly safe options have not seen the "horror stories" that doctors see.

In recent years, studies have offered different statistics on the safety of home births. A 2005 study in the British Medical Journal found that home birth had a similar mortality rate to that of low-risk hospital births. But a 2011 statement by the American College of Obstetricians and Gynecologists says published medical evidence shows that planned home births carry a two- to three-fold increase in the risk of newborn death compared with planned hospital births.

Frame said it is hard to come by maternal morbidity rates during home births because those deaths are attributed to hospitals that are often trying to help a patient brought in after a home birth has gone bad. He said home births sound great, but mothers who choose to deliver at home are thinking only of themselves.

"It's 'I want, I want, I want,' " he said. And they come in with a mindset that doctors and nurses are the bad guys, he said.

"I choose not to be set up to be the fall guy," he said.

Frame strongly advises against home births.

"Don't do it," he said. "It's more dangerous."

Other natural options

But home birth is not the only option for people looking for natural births. Lynne Burson, a midwife with OU physicians, said the majority of certified nurse midwives - those trained as nurses - work in a hospital.

There are five midwives on the OU team, and they deliver babies at Hillcrest Medical Center and the Peggy V. Helmerich Women's Center.

Midwives work with patients who are low-risk, Burson said. They are able to spend a little bit more time with patients, allowing labors to progress in a natural way. In many instances, they are able to accommodate the patient's wishes, such as not receiving an epidural or not having their labor artificially accelerated.

But she says there is a delicate balance between being able to accommodate patients' wishes and following hospital procedure. For example, if a patient who has had a previous cesarean section asks to eat throughout her labor, midwives cannot allow it, in case the patient needs another c-section.

"But most of the requests we can accommodate," she said.

All parties encourage women to educate themselves before making a decision. But Frame cautions against relying solely on home birth advocates for information.

Original Print Headline: Home delivery

Nour Habib 918-581-8369
nour.habib@tulsaworld.com

Associated Images:

Rachel Driver holds her newborn daughter, Jocelyn, at her apartment. Driver opted for a home birth and delivered Jocelyn into a water tub in her living room. MICHAEL WYKE/Tulsa World

Brandi Stone (left), an apprentice midwife, checks on expecting mother Rachel Driver during a visit to her apartment. Driver was 34 weeks pregnant and planned to deliver the child at home. MATT BARNARD/Tulsa World

Jon and Rachel Driver hold their newborn daughter, Jocelyn. "I was able to rub (Rachel's) back, help her, get her water if she needed it, instead of being the middleman who had to ask permission for everything," Jon Driver said of the benefits of a home birth. MICHAEL WYKE/Tulsa World