Hospital stay not part of process for some moms

For Angela Hirsch, the decision to give birth to her second child at home was fairly easy. Her daughter was born in a hospital, and the experience had left her feeling that she wanted a more comfortable setting.

That’s something many home birth advocates cite when they talk about the advantages of home birth.

“All the prenatal care was done at home,” says Ms. Hirsch, a press officer with the Coast Guard who lives in Northwest Washington. She contacted the midwives at Metro Area Midwives Allied Services (MAMAS) at the midpoint of her second pregnancy.

“We had leisurely visits, I made tea, and they answered all my questions. You really got the sense that they love what they do,” she says.

Home birth has become a hot topic these days, thanks to a spate of high-profile celebrity interviews and a rush of recent media accounts. Actually, less than 1 percent of U.S. babies are born at home, but the question of home birth itself, whether it is safe, better for the baby or simply a recent fad, is contentious.

“There is definitely a resurgence of interest in home births,” says Alice Bailes, a certified nurse midwife and co-director of Birthcare and Women’s Health Ltd. in Alexandria.

Both the American Medical Association (AMA) and the American College of Gynecologists and Obstetricians (ACOG) have reiterated their opposition to home births, citing safety concerns and the expertise of the midwives who attend them. Nevertheless, a recent study of 13,000 births published in the Canadian Medical Association Journal, which prompted a number of the most recent news stories, says home births are as safe as hospital births for a low-risk population. Other studies make similar claims.

Both sides acknowledge that home births are not for everyone, especially if a woman has had a previous Caesarean section, is diabetic, has high blood pressure, or has given birth prematurely. But even low-risk pregnancies can have unforeseen complications.

“Everyone knows, and everyone understands, that there needs to be a mechanism to transfer a mother to a hospital setting,” says Ms. Bailes, who notes that about 11 percent of her clients end up being transferred to a hospital.

To be sure, a hospital experience can be daunting, especially these days when procedures such as episiotomies and enemas, IV hookups, and fetal monitors are routine. So are C-sections, once seen as a last resort, now performed with increasing regularity.

“The picture of birth in America today is startling,” says Jo Anne P. Davis, a certified nurse midwife and an assistant professor and midwifery tutor at Georgetown University School of Nursing. “One in three women are being surgically delivered. The maternal mortality rate has experienced a slight rise in the last decade, and the premature rate is going up.”

Yet Ms. Davis notes that the atmosphere around home births has changed as professional medical organizations “ratchet up” the rhetoric against birthing at home.

“The connection between home and hospital should be seamless,” she says. “There should be a flexible network of care that adjusts to women’s needs.”

Having babies in the hospital was not the choice for most women as recently as 70 years ago, notes Judith W. Leavitt, a professor of medical history at the University of Wisconsin and author of “Make Room for Daddy: The Journey From Waiting Room to Birthing Room.”

According to Ms. Leavitt, as late as 1938, only about half of American births took place in a hospital. Before 1920, only about 5 percent did. By 1955, fully 95 percent of Americans were being born in a hospital.

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