When John Tittle’s wife, Sarah, told him she wanted to give birth to their first child at home, he was filled with doubts.
My sisters and I were all born in hospitals," the 30-year-old Tempe man said. "Everyone I know was born in a hospital. That’s just what you do. So when Sarah brought up using a midwife and go i ng the home birth route, I was nervous and skeptical."
But the number of skeptics is decreasing. In part because of the dramatic increase in medical interventions during hospital deliveries —the number of women being induced into labor doubled during the 1990s and the number of Caesarean sections has quadrupled since 1970 — more women are choosing back-to-basics births in their homes. The number of babies delivered by midwives has grown from 1 percent in 1975 to more than 7 percent in 2001, acco rd i n g t o t h e National Center for Health Statistics.
"More wealthy women are having home births now," said Mary Henderson of New Life Midwifery in Phoenix. "Women are more educated. They don’t like going in and having someone tell them how to have their babies."
Cheri Casciola of Chandler delivered her four children at home using a midwife.
"I felt so much safer and in control," the 32-year-old said. "Your midwife becomes your best friend, and I’ve never heard anyone say that about their doctor. Your midwife is with you right from the beginning of the pregnancy until after the baby is born. They don’t just show up in time to catch the baby."
A Public Citizen’s survey found that midwives spend an average of 49.3 minutes with expectant mothers on their first visit, compared with 29.8 minutes for doctors. Subsequent visits average 29.3 minutes for midwives and 14.6 minutes for doctors.
It also costs less to get more attention, midwives said. Henderson and New Life partner Sue DiSilvestro of Chandler, charge $1,800 for complete childbirth care, about one-third what it would cost for an uncomplicated hospital birth. And most insurance companies cover midwives.
"I do everything from the very first exam and taking the pregnancy test to every single prenatal checkup, labor, delivery, cleaning up after the birth and six weeks of postpartum exams," said Tempe’s Wendi Cleckner, a direct entry midwife who coached Sarah Tittle through the home birth of her daughter Abby.
Direct entry midwives are as low-tech as mother’s milk. They must refer out medical tests. They don’t use any pain medication. They are not allowed to deliver babies in hospitals or in birthing centers, only in the home.
"Through all my research and studies, I found that home births were remarkably safer than any outcome would be in a hospital with everything being on equal parallels," Casciola said.
But the American College of Obstetricians and Gynecologists disagrees. Unpredictable hazards to both mother and child "require standards of safety which are provided in the hospital setting and cannot be matched in the home," the group’s policy states.
"You don’t know what the midwife’s ability is to discern situations beyond their expertise," said Dr. Patricia Lanter, an OB/GYN at CIGNA Medical Group in Tempe. "Obstetricians get a bad rap that we’re trying to do extra things to people, and midwives are au natural. That’s not the case. When I get called out of bed at two o’clock in the morning, I just want to deliver your baby and hand it to you. I have no desire to perform extra procedures because it’s just more work for me."
But not all medical professionals share that opinion.
"When it comes to labor and delivery, everything I learned in nursing school was abnormal," said 24-year-old Tempe nurse Joanie Foote. "They look at birth as a disaster that’s supposed to happen. I’ve seen more C-sections than vaginal births, and that freaks me out."
Foote, whose first child is due in August, decided to bypass the medical setting she works in all day and use a midwife to deliver her baby.
"I want to be completely present during my birth," Foote said. "Talking with my midwife has given me a whole new outlook on birth and how it’s supposed to be a natural process without all the complications."
One way midwives say they avoid complications during the natural process is by only working with low-risk women.
"We won’t work with mothers who are expecting twins, have diabetes or have high blood pressure," said DiSilvestro, a mother of seven. "If any of those risks are present, we tell them to work with a doctor."
DiSilvestro and Henderson said they only send about two out of 100 mothers to a hospital because of complications. That is a low number considering the Caesarean section birth rate in hospitals is more than 20 percent, according to 2001 National Vital Statistics Reports.
"God made the process of having a baby extremely perfect," Cleckner said. "We can’t add anything to perfection. We just allow the woman to do what they know how to do naturally."
Which was the primary appeal to Tittle, who didn’t want to risk having an unnecessary Caesarean section, didn’t want an epidural that may harm her baby and didn’t want an episiotomy.
"I wasn’t nervous about not having access to pain medication until the day I went into labor," the 26-yearold said. "There was a point where I was in the shower and having contractions and I was like, ‘If I was in a hospital right now, I’d take an epidural.’ But I was glad I wasn’t. Having the baby at home seemed very natural and comfortable."
And for her husband, it allowed him to be part of the event he called "the most beautiful thing in the world."
"I was allowed to catch the baby and I was just in awe," he said. "I immediately brought Abby up to Sarah and she started breast feeding. It was such an incredible bonding moment. And it was right there in our own home."
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