VitalChild - birthing the old-fashioned way

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Birthing the old-fashioned way
Source: Sfgate.com (mommy files) Date: 11/27/08

Just a few days before her due date, Claire Alexander was told by UCSF Medical Center that she should stay at the hospital for observation. Her baby's heart rate showed a deceleration and the attending obstetrician wanted to monitor it.

But instead of checking into a hospital room, Alexander returned to her home in the city's Richmond district, climbed into a tub of water with her husband, and pushed out a healthy baby girl.

"We floated in the tub with her for a little while enjoying the postbirth euphoria," Alexander says. "It was an amazing experience."

California licensed midwife Maria Iorillo was at the birth guiding Alexander through the experience. Iorillo was also at UCSF when a labor and delivery nurse hooked Alexander up to a monitor and an on-call resident said, "We strongly advise you to stay here."

But Alexander knew she wanted to give birth at home--she had planned on this for months--and Iorillo requested that Dr. Julian Parer, an expert on fetal heart tones, assess the situation. Dr. Parer determined that Alexander was safe to go home.

"I think Maria views herself and the hospital as partners," Alexander says. "She's not intimidated in the face of the medical establishment yet she works hard to not create a confrontational scene at the hospital. Sure, she wants what the mom wants, a home birth. But the primary thing is the safety of mom and baby, and deliberate, thought-out, informed decisions are what she's after. She stood up for me when I was too intimidated by the machinery, the staff, and the hospital gown to stand up for myself."

In San Francisco the old-fashioned way of birthing is back in style. More and more women such as Alexander want to birth in their own bed or tub, free from medical interventions such as labor-inducing medication and C-sections that are staples of hospital deliveries. According to the National Center for Health Statistics, home birthing accounts for less than one percent of all U.S. deliveries, and this number has remained the same for many years. But in San Francisco, the number of home births is rising. According to the San Francisco Department of Public Health, 94 women delivered outside the hospital in 2006. The 2008 number is currently 128 and will likely climb to 140 or higher by the end of the year, according to the department's Office of Vital Records.

"When I started in this business in 2006, we had only one birth tub," says Cara Vidano, owner of Natural Resources, a pregnancy and childbirth resource center in the Mission district. "Now, I have eight and they're booked three months out. Every month, I get calls from people who want a birth tub and I have to turn them away."

"I'm busy, busy, busy--booked through summer," says certified nurse midwife Nancy Myrick of Rites of Passage. "I limit my business to three to four home births a month, but there are months when I get 20 phone calls. Two years ago, there were some months when I had only one birth."

Many midwives such as Myrick believe the 2008 documentary the Business of Being Born is one of the reasons for the increase. Executive-produced by former talk show host Ricki Lake, the movie makes a strong case for drug-free home births and suggests that the rise in C-section surgeries in recent years (one in three births end in a C-section) is a "doctor-friendly" trend that helps hospitals avoid malpractice suits and moves women out of the maternity ward faster. It reveals that in most advanced countries, midwives reduce the need for Cesareans and improve survival rates for mothers and their children.

"San Francisco was one of three cities where the Business of Being Born premiered," says licensed midwife Abigail Reagan, who started her practice Rebirth Midwifery five years ago. "The film was supposed to run for three nights after the premiere. But the crowds were so great that it screened for three more weeks. After that, the phones started ringing."

Midwife Maria Iorillo says the San Francisco community has fostered the home birthing movement. The city is full of midwives and St. Luke's, UCSF, and Kaiser hospitals all work with them and provide collaboration if necessary (CPMC doesn't allow home birth collaboration due to insurance issues). "Even in the East Bay, it's not as friendly and cooperative," says Iorillo, who opened her home birthing practice Wisewoman Childbirth Traditions in 1987. "At Alta Bates, they don't have any doctors who are willing to work with you. Kaiser in Oakland is a little better."

Most home births are attended by a midwife, a licensed health care professional trained to provide prenatal care, guide labor and birth, address complications, and care for newborns. Most midwives charge $4,000 per birth (much less than the price of delivering in a hospital) and insurance companies often cover half the cost. Midwives say they accept only low-risk clients, and the pregnant woman typically chooses a collaborating hospital. An estimated 12 to 20 percent of all home births transfer to a hospital, mostly for pain medication and labor augmentation. Midwives insist they practice preventively, knowing when technology only available at a hospital is necessary.

A study published in 2005 in the British Medical Journal found that home birthing had a similar mortality rate to that of low-risk hospital births. This particular study took into account all home births involving a certified professional midwife (CPM) in the United States and Canada in 2000. "A lot of home birth studies are based on birth certificates and don't take into consideration people who didn't plan a home birth," Iorillo says. "Some of these women had no prenatal care and didn't have a midwife present at the birth."

Despite the evidence supporting planned home birth as a safe option for women with low-risk pregnancies, the home setting remains controversial. The American Medical Association and the American College of Obstetricians and Gynecologists (ACOG) believe a hospital or an accredited birthing center is the safest setting for labor, delivery, and the immediate postpartum period.

"ACOG doesn't formally oppose home birthing but our position definitely implies that," says Dr. Erin Tracy, an ob-gyn at Massachusetts General Hospital and vice chair of ACOG Massachusetts. "No one at ACOG is advocating for criminalizing home birthing. We just personally think it's much safer to give birth in a hospital or at a birthing center. I think the vast majority of women who give birth do fine, no matter where they do it. But there is a certain number of low-risk pregnancies that become high-risk minutes before their babies need to be delivered. How does someone who needs help within minutes get from home to a hospital in time? Another concern is the lack of availability of potentially life-saving techniques, including Cesarean sections, blood products, and medications in the home setting."

But while some doctors argue that things can go wrong at home, many women opt for a home birth because things went wrong for them at the hospital the first time around. Claire Alexander says her experience with her first child led her to a home birth. When she checked into the hospital, attendants failed to recognize that Alexander was far along in her labor and left her and her husband alone in the room. "I reached down and I could feel the baby's head. The outcome was good but I felt like we could have easily done this ourselves at home."

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