Mothers, midwives, physicians reckon with home birth options

St. George mom Cassidy Miller shows off her baby bump and young daughter | Courtesy of Janae Sherman

ST. GEORGE – The age-old practice of having a baby at home is regaining popularity, to the displeasure of some and the delight of others.

Understanding home birth

Though home birth dates back to the first days of humanity, its frequency in the United States declined sharply during the 20th century as medicine was modernized and hospitals and health insurance became more accessible to the general public. An estimated 50 percent of babies were born at home in 1935; by 1955, that number had decreased to a mere 1 percent. Over the last 20 years, the rate of home births has remained at approximately 0.65 percent.

However, this infrequency has not stopped women from seeking an alternative to the now-routine hospital birth. For many, a variety of physical and emotional factors contribute to their choice. A series of interviews conducted in 2009 by the Journal of Midwifery and Women’s Health found five main reasons home birth appeals to mothers: Safety, avoidance of unnecessary medical interventions, past negative hospital experiences, being in control and more comfortable surroundings.

“My biggest fear was having my baby in the hospital,” Bria LeFevre, a St. George resident who had both her children at home, said. “A hospital is a place for sickness and problems and being there (for a checkup during my pregnancy) gave me a glimpse of how cold my childbirth could have been.”

Keeping with this theme, home births are primarily focused on the mother and are tailored to her needs and desires. She is given access, if wanted, to relaxation aids such as a birth pool or birthing ball and the freedom to position herself however she wants during labor, privileges that would not be available in most hospitals. Supporters of natural childbirth also gravitate towards the practice, as many home births are without any type of pain relief.

Modern home births are classified as either attended or unattended. Most are attended, which means that a professional, such as a certified midwife or nurse who can provide minimal medical aid, accompanies the mother. Unattended births occur when the mother is accompanied only by relatives, friends or a nonprofessional such as a doula (labor coach); this method is sometimes called freebirth. Least common are solo births, when the mother delivers her baby entirely alone. But regardless of method, the general goal of home birth is for the mother to enjoy the experience, at least more so than she would in a hospital.

The controversy

Home birth has both passionate supporters and detractors within and outside of the medical community. Those against it cite a lack of safety as the main concern, as mothers who deliver at home have access only to minimal care and are often not accompanied by qualified medical professionals. And due to lack of education and experience, midwives may not be able to recognize complications threatening the health of the mother and child, or decide when going to a hospital is necessary.

Dr. Robert Fagnant, an obstetrician hospitalist at Intermountain Healthcare Southwest Region at Dixie Regional Medical Center, said that his staff encounters women at least twice a month who hoped to give birth at home but, due to complications, had to abandon their plan. In his 25-year career, he has also seen several babies die during labor and stressed the importance of good preparation to ensure a successful delivery.

“Any woman who has an illness, has had uterus surgery, is before or after their (due date), (is carrying) multiple babies, a large baby or (breech) baby should not deliver at home,” he said. “It’s also important for women to (have an) experienced and knowledgeable attendant so they can know when it’s time to have a hospital birth.”

Midwife Janae Sherman holds a patient’s newborn baby | Courtesy of Janae Sherman

Those for home birth, who typically include midwives, advocate that healthy mothers with low-risk pregnancies should be able to choose their birth experience. It has been suggested that delivering in a familiar environment reduces stress and pain and may even contribute to an easier labor and healthier baby. A myriad of studies have been conducted on the risks of home birth versus hospital birth with no conclusive results, due mainly to the low percentage of babies born at home.

“I think there just isn’t enough education on home birth, (because) some people have the misconception that midwives are anti-doctors and anti-hospitals,” midwife Janae Sherman said. “We are not. We are here for those women and families who just want a different experience. We support a woman’s choice to deliver where (she wants), and will do whatever we can to accommodate that.”

A professional midwife and doula, Sherman has attended over 200 births during her career and has also given birth to her own three children at home. Only a small percentage of her patients ended up having a hospital birth and she said that while the emphasis is on natural methods, every situation is different.

“As with anything, there are risks involved in birth,” she said. “Parents need to look into all options and decide what is best for them. Education and support are the key issues.”

Finding common ground

In response to the demand for more personal care for expecting mothers, Intermountain’s DRMC has broadened its scope of services beyond just a delivery. A pair of low-intervention rooms was added this year. Amenities such as more space and privacy, music and hot tubs provide a home-like feel, but with doctors and anesthesiologists only seconds away. The hospital also offers childbirth education classes, hypnobirth classes (using hypnosis to reduce labor pain) and aromatherapy.

“If a mother wants to come in with a birth plan, we’ll work with them to give them the experience they want,” said Amy Christensen, director of Women’s and Children’s Services. “We really want to provide a good experience.”

Sherman has collaborated with doctors at Intermountain’s DRMC during her career and said that she is grateful for the respect and understanding the doctors have shown her and her patients; the general attitude is not against home birth, but for a healthy and happy mother and baby. The only way that is possible, though, is by educating oneself on both the risks and rewards.

Dr. Fagnant said, “My preference is for everyone to be born in the hospital, but ultimately it’s every woman’s choice.”

 

Email: AlexaVM@stgnews.com

Twitter: @STGnews

Copyright St. George News, SaintGeorgeUtah.com LLC, 2012, all rights reserved.

Free News Delivery by Email

Would you like to have the day's news stories delivered right to your inbox every evening? Enter your email below to start!

Posted in NewsTagged , , , , ,

11 Comments

  • Ashley August 24, 2012 at 9:37 am

    Great article!

  • Corina Fitch August 24, 2012 at 10:35 am

    Thanks for bringing attention to this important issue. I am a licensed midwife and registered nurse and I would like to clarify a couple of points. First, midwives ARE educated and do know how to both identify complications and know when to transfer care, as well as handle emergencies in the moment as needed. My program was 3 years and included both academic and didactic learning, with strict clinical requirements for licensure. Midwives are trained to be experts in normal pregnancy and birth and to know when transport is necessary. As far as experience, this varies greatly both with midwives and doctors so it is a good idea for women to ask about a provider’s experience level when making a choice about who will care for them during pregnancy. In regards to claims about lack of data, there are numerous studies spanning the last 30 years which have compared low risk women delivering in hospitals with those birthing at home. Outcomes have shown no statistically significant difference between the two in terms of safety but have found much fewer rates of intervention in the home birth group. In addition the countries in the world that have the best outcomes use midwives as the primary providers for pregnant women and have home births rates as hi as 30%. The controversy about home birth in this country is not really about safety it’s about money and power.

  • Murat August 24, 2012 at 12:07 pm

    I approve of home birth if the practitioners are properly trained. I generally disapprove of hospitals as they are breeders of infection. Doctors and nurses are often disgusting cesspools of germs and disease.

    • Dghws August 24, 2012 at 9:45 pm

      Murat you were doing so good, voicing your opinion and commenting on the article, up until you decided to call doctors and nurses names. Not sure if this is just your way of stamping your comments with an exclamation point or if you really do have such a negative view of everyone who isn’t you.

      • Murat August 25, 2012 at 2:50 pm

        I know that you are not a very bright person, which is why I don’t care about your opinion. Nevertheless, I never make unsubstantiated claims. A substantial percentage of doctors and nurses are about as hygienic as street bums who surround themselves with their own feces. There are a number of factors that go into this, but if you’ve researched the matter or even casually paid attention to general interest health news you would already know.

  • Fred August 24, 2012 at 12:37 pm

    Great article. We had 3 of 5 kids at home. A great experience. Yes im the dad but my wife agrees. It was her idea in the first place.

  • I sent this earlier today to the email listed in this article, but would like to address this here as well.

    I find myself asking where the research is. I am a Home Birth Midwife here in St. George – one with a zero transfer rate in labor – and a birth advocate. I see that you mentioned a study that was released, highlighting why some women might choose to birth at home, but then you erroneously stated:

    “A myriad of studies have been conducted on the risks of home birth versus hospital birth with no conclusive results, due mainly to the low percentage of babies born at home.”

    Yes, many studies have been done comparing home birth to hospital birth among low risk women since the 1970s. In fact, there have been 17 studies in the last 15 years alone. Even more when you include the number of studies done outside of the U.S. which shows better outcomes over all, outside of the hospital. But they all have one thing in common: They all show, very conclusively, that not only is home birth just as safe as hospital birth but that there is a much lower incidence of maternal morbidity when birthing at home. Fewer unnecessary interventions such as induction/augmentation of labor, artificially rupturing the amniotic sac, delivering in the lithotomy position, episiotomy, and instrumental deliveries lead to much better outcomes on the level of injury to mom and/or baby.

    While I have had nothing but an amazing professional relationship with several Obstetricians in town, and while I thoroughly respect Dr. Fagnant for the positive changes that he has made within the labor and delivery department of DRMC, I disagree with a few of his statements.

    There is no research to back up his blanket statement of which conditions preclude birthing at home. While there are most definitely situations and circumstances that may preclude a woman from birthing at home with a Midwife, it is not evidence-based to simply state:

    “Any woman who has an illness, has had uterus surgery, is before or after their (due date), (is carrying) multiple babies, a large baby or (breech) baby should not deliver at home,”

    It entirely depends upon which illness he speaks of. One cannot simply state that any women with an illness should not birth at home. While there are certainly illnesses that would necessitate a hospital birth, some chronic illnesses may not require it. Some conditions that might require hospital birth would be uncontrolled, insuline dependent diabetes; illness with medications that caused abnormalities in the fetus; certain heart conditions, etc

    As a mother who has had a VBAC (Vaginal Birth After Cesarean) at home, as a woman who has been researching VBAC for the past seven years, and as a Midwife who fully supports women who have had prior cesarean surgery, I also disagree that this precludes women from birthing at home. The research shows us that the main risk associated with VBAC is uterine rupture, and this occurs in 0.3-07% of VBACs. Less than other emergencies, such as cord prolapse, that would necessitate immediate hospital transfer. With a care provider who knows the research, who is experienced with VBAC, and who isn’t afraid to transfer if anything seems to be off, VBAC at home can be very safe and continues to be a reasonable choice. For many women, it is the hospital or physician protocol which puts them in the position of choosing to birth at home after a prior cesarean. Some hospitals have banned VBAC altogether. Most have certain criteria for VBAC labors that must be closely followed. Sadly, many VBAC hopefuls find themselves in the operating room again, and know it was avoidable.

    As to his statement about not birthing at home if you are before or after your due date, again I ask where the research is. Any skilled Midwife that I know would not attend a woman at home who is less than 36/37 weeks gestation. However, 37 weeks is full term and is normal for some women. For others, it can be completely normal and a part of their maternal history to gestate until 42/43 weeks. With proper monitoring, research shows us that expectant management is completely acceptable in terms of risk/benefit. Many women do not understand that normal gestation length is 38-42 weeks. Most believe that they are “overdue” and at risk beyond 40 weeks. This is simply not true.

    Twins and breech babies can also be birthed at home without complication, with a skilled care provider. A Midwife who is experienced with multiples and breech knows what to look for in risk assessment, and knows which women should be in the hospital and which are safe to deliver at home. In the hospital, moms of multiples or of breech babies are often limited to cesarean surgery. Or may be allowed to birth twins vaginally, but in the operating room. Understandably, some women don’t want to spend this most incredible and life-changing event in a cold, bright operating room with the thought of surgery being so close.

    As a mom of ten pound babies, I am concerned with the blanket statement that women carrying a large baby should not birth at home. Weight is not nearly as relevant as head circumference. So much is misunderstood about the ability to birth babies of all sizes, particularly when there are no abnormalities causing the size of baby. There are things that make a dramatic difference in the ease of birthing a large baby. Mobility, ability to get into different positions that open the pelvis more than the semi-sitting or lithotomy position, and patience. Most often, these things are not available in the hospital. While there are wonderful Obstetricians who are thoroughly researched and are willing to offer these things to women, it is more the exception than the norm. One also takes into consideration that it is the structural size of the baby that matters, not how many pounds the baby weighs at birth. I have often heard of care providers stressing induction of labor at 40 or 41 weeks because, “The baby looks to be getting quite large.”. However, the baby’s structural size does not change between 40-42 weeks. For example, my 10lb 10oz VBAC baby, who was born onto my bed at home, had the same exact head, shoulder, and chest size as my friend’s 8lb baby. It is simply not evidence-based to say that all women with a large baby should not birth at home.

    I can completely understand Dr. Fagnant’s concern with the transfers that he sees each month. I am concerned with particular things as well, regarding the health and safety of moms and babies at home. There are certain practices and beliefs in our community which have caused incredibly concerning transfers. I know that sometimes all care providers are lumped together, and I find this particularly true of the reputation of Midwives as a whole. But it is damaging for Dr. Fagnant to mention transfers, and then mention the deaths that he has seen in his time as an Obstetrician. An Obstetrician is simply going to see more death than a home care provider, because Obstetricians deal with not only higher risk pregnancies, but also have much higher rates of intervention in labor. Obstetricians deal with things like labor-inducing drugs which have side effects – including death – to go with them. They deal with emergencies that are more prevalent with intervention, such as cord prolapse, hemorrhage, and embolism.

    So many aspects of pregnancy, labor, and birth are misrepresented and risks are inflated. Unfortunately, most people are less likely to do research than they are to take an authority figure’s word as gospel. The concrete research is there. It is vitally important for families to thoroughly research their options in childbirth, and their potential care provider. But there has to be balanced information based on empirical research.

    http://www.greenmedinfo.com/blog/myth-safer-hospital-birth-low-risk-pregnancies
    http://www.greenmedinfo.com/blog/myth-safer-hospital-birth-low-risk-pregnancies http://www.cmaj.ca/content/181/6-7/377.abstract
    http://www.bmj.com/content/330/7505/1416.abstract
    http://www.ncbi.nlm.nih.gov/pubmed/9271961?dopt=AbstractPlus

    • Nadine August 24, 2012 at 11:55 pm

      Christine Fiscer, thank you for your extremely well-thought out and well- worded comment. I am a mom of two who birthed one of my babies at home unassisted and also a hypnobirthing childbirth educator. I agree with you on all fronts. Too many times ObGyns provide sweeping blanket statements like that not only scare families into acquiescing to the doctors wishes , but also leave them feeling inadequate and insecure about their bodies ability to birth naturally. This then can manifest itself in physical complications as seeds of doubt have been planted, and so the vicious cycle. Doctors need to have more faith in nature’s handiwork and the perfectly designed female body. There are amazing doctors who stand up for our rights , but few and far between.
      Thank you Christine for setting the record straight

      • Murat August 25, 2012 at 3:25 pm

        I take issue with your statement that the female body–or any body or organism for that matter–is ‘perfectly designed’. What an idiotic thing to say. What are you going to say next, that Jesus is our savior? Give me a break!

  • Ashlie December 8, 2012 at 11:22 pm

    I personally have no issue with whether a mother chooses to birth at home or the hospital, but as long as the midwife is most concerned about her patient and not her transfer stats, then they are pretty knowledgeable about birth.

    I have many friends who have chosen to give birth at home and have a strict ‘plan’. Well, I think mother’s know this best, but baby’s change plans…and it is more important to be safe and transfer when needed than stick to a plan.

    And I do agree that hospitals are safer, not for the birthing process, but for issues after birth; baby’s lungs sticking to their chest, mothers going unconscious….etc. I know many people whose babies would’ve died at home. And I know equally as many people who have had no complications whatsoever at home. It’s more or less personal choice.

    I don’t agree with the attitude some midwifes keep that doctors are ‘out to get’ mothers. That they are uneducated or incompetent. Everything a doctor does needs written consent…so it’s the person signing that consent form, who is fully aware of any risks, that is responsible, not the doctor. They are there to save lives. Midwives are there to help you love your experience and be more of a empathetic support system.

  • shameonbetterbirth July 30, 2013 at 9:01 am

    I would be more accepting of home birth if midwives in the state of utah were required to be licensed. I found out the hard way that your midwife can pretend to be licensed and then mistreat you- there is basically no way to reprimand them after that. I am lucky that my baby wasn’t harmed.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.